Provider Demographics
NPI:1265750111
Name:PARKER, ANDREW CHARLES (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHARLES
Last Name:PARKER
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 1:3002 FOREST COVE DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2032
Mailing Address - Country:US
Mailing Address - Phone:757-472-5892
Mailing Address - Fax:
Practice Address - Street 1:3002 FOREST COVE DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2032
Practice Address - Country:US
Practice Address - Phone:757-472-5892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-16
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196763207P00000X
VA0101254415207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine