Provider Demographics
NPI:1265415483
Name:LOCKSHAW, ANDREW J III (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:LOCKSHAW
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 E MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1545
Mailing Address - Country:US
Mailing Address - Phone:330-755-3233
Mailing Address - Fax:330-755-4511
Practice Address - Street 1:296 E MANOR AVE
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1545
Practice Address - Country:US
Practice Address - Phone:330-755-3233
Practice Address - Fax:330-755-4511
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAJL0598321Medicaid
OHLO0569451Medicare ID - Type Unspecified
OHAJL0598321Medicaid