Provider Demographics
NPI:1356611990
Name:MCGONIGLE, ANDREA MICHELLE (MD)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:MCGONIGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:LEVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0005
Practice Address - Country:US
Practice Address - Phone:310-794-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136794207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology