Provider Demographics
NPI:1972687085
Name:PALERMO, ANDREA S (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:S
Last Name:PALERMO
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 1:1 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1875
Mailing Address - Country:US
Mailing Address - Phone:609-567-0200
Mailing Address - Fax:609-567-1169
Practice Address - Street 1:1125 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-348-0066
Practice Address - Fax:609-348-1157
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB06634300208M00000X
NJ25MB06634300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02588172Medicaid
MD7666021Medicaid
PA001776870Medicaid
NJ8255300Medicaid
NY02588172Medicaid