Provider Demographics
NPI:1790786911
Name:LOCANDRO, DREW MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:MATTHEW
Last Name:LOCANDRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LACY ST NW
Mailing Address - Street 2:NORTHWEST ENT AND ALLERGY CENTER
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060
Mailing Address - Country:US
Mailing Address - Phone:770-427-0368
Mailing Address - Fax:678-581-5969
Practice Address - Street 1:80 LACY ST NW
Practice Address - Street 2:NORTHWEST ENT AND ALLERGY CENTER
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-427-0368
Practice Address - Fax:678-581-5969
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31970207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00403851EMedicaid
GA04BDCGLMedicare PIN
GAGRP4034Medicare PIN
GA00403851EMedicaid