Provider Demographics
NPI:1639296262
Name:SYMULA, ANDREW J (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:SYMULA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2200
Mailing Address - Country:US
Mailing Address - Phone:804-359-1768
Mailing Address - Fax:804-359-1928
Practice Address - Street 1:3536 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2200
Practice Address - Country:US
Practice Address - Phone:804-359-1768
Practice Address - Fax:804-359-1928
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305204096OtherSTATE HEALTH LICENSE
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