Provider Demographics
NPI:1295933653
Name:TENNER, ANDREA GAIL (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:GAIL
Last Name:TENNER
Suffix:
Gender:F
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 1:110 S PACA ST FL 6
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1645
Mailing Address - Country:US
Mailing Address - Phone:410-328-8025
Mailing Address - Fax:
Practice Address - Street 1:110 S PACA ST FL 6
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1645
Practice Address - Country:US
Practice Address - Phone:410-328-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125050033207P00000X
NY60257667207R00000X, 207P00000X
IL036080967207R00000X
MDD0073918207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine