Provider Demographics
NPI:1912022799
Name:PRYCHODKO, ANDREW W (MD MPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:PRYCHODKO
Suffix:
Gender:M
Credentials:MD MPH
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 292456
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75029
Mailing Address - Country:US
Mailing Address - Phone:972-421-0431
Mailing Address - Fax:
Practice Address - Street 1:800 N INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-7400
Practice Address - Country:US
Practice Address - Phone:817-571-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE30232083P0500X, 209800000X, 207Q00000X
MI4301-0461322083P0500X, 209800000X, 207Q00000X
CAG661692083P0500X, 209800000X
TXJ8093207Q00000X, 2083P0500X, 209800000X, 2083A0100X, 207QA0401X
NY2549592083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE50137Medicare UPIN
TXE50137Medicare UPIN