Provider Demographics
NPI:1891722856
Name:KOTZUR, ANDREAS (MD)
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:
Last Name:KOTZUR
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:PO BOX 784305
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-4305
Mailing Address - Country:US
Mailing Address - Phone:844-565-6473
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:1310 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4623
Practice Address - Country:US
Practice Address - Phone:202-574-6851
Practice Address - Fax:202-279-7370
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248705207L00000X
CA70090207L00000X
MDD0078086207L00000X
MI4301106486207L00000X
DCMD034204207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00029933OtherRAILROAD
DC034439900Medicaid
DCP00029933OtherRAILROAD