Provider Demographics
NPI:1891790754
Name:TEWELL, ANDREA (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:TEWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1700
Mailing Address - Country:US
Mailing Address - Phone:937-746-8357
Mailing Address - Fax:937-746-1992
Practice Address - Street 1:909 E 2ND ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1712
Practice Address - Country:US
Practice Address - Phone:937-746-8357
Practice Address - Fax:937-746-1992
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2135700Medicaid
OHG82279Medicare UPIN
OHTE0857703Medicare ID - Type UnspecifiedMCR PROVIDER #