Provider Demographics
NPI:1902817018
Name:DEMICHELE, ANDREW H (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:H
Last Name:DEMICHELE
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 8157
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-8157
Mailing Address - Country:US
Mailing Address - Phone:302-652-6050
Mailing Address - Fax:302-652-6053
Practice Address - Street 1:1500 SHALLCROSS AVE
Practice Address - Street 2:SUITE 1 A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3037
Practice Address - Country:US
Practice Address - Phone:302-652-6050
Practice Address - Fax:302-652-6053
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058617L208600000X
DEC10007635208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005353635OtherAETNA PIN
DE1000035615Medicaid
PA0016931600005Medicaid
DE0005353635OtherAETNA PIN
DE0005353635OtherAETNA PIN
PA008741Medicare PIN
DE017665M49Medicare PIN