Provider Demographics
NPI:1255451654
Name:PESHEK, ANDREW DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DONALD
Last Name:PESHEK
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 1:2531 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4207
Mailing Address - Country:US
Mailing Address - Phone:267-307-2340
Mailing Address - Fax:
Practice Address - Street 1:128 CHESTNUT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3024
Practice Address - Country:US
Practice Address - Phone:215-928-1280
Practice Address - Fax:215-928-1281
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4205412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI50801Medicare UPIN