Provider Demographics
NPI:1336145192
Name:SHOWALTER, ANDRA G (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRA
Middle Name:G
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8201 ATLEE RD
Mailing Address - Street 2:STE B
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1815
Mailing Address - Country:US
Mailing Address - Phone:804-730-5222
Mailing Address - Fax:804-730-5225
Practice Address - Street 1:1401 JOHNSTON WILLIS DR
Practice Address - Street 2:STE 4100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-323-1401
Practice Address - Fax:804-323-1850
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101058078207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7603967Medicaid
VAH58013Medicare UPIN