Provider Demographics
NPI:1659346724
Name:HREHOCIK, ANDREA L (PAC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:HREHOCIK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:814 N HOUCKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1882
Mailing Address - Country:US
Mailing Address - Phone:410-239-0406
Mailing Address - Fax:410-239-0407
Practice Address - Street 1:814 HOUCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074
Practice Address - Country:US
Practice Address - Phone:410-239-0406
Practice Address - Fax:410-239-0407
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C0002831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q18240Medicare UPIN