Provider Demographics
NPI:1508612128
Name:EDMEADE, ANDREA CRYSTAL (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:CRYSTAL
Last Name:EDMEADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:CRYSTAL
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 N STATE ST CLINIC TOWER A7E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-1001
Mailing Address - Country:US
Mailing Address - Phone:323-409-5126
Mailing Address - Fax:323-441-8193
Practice Address - Street 1:1100 N STATE ST CLINIC TOWER A7E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-1001
Practice Address - Country:US
Practice Address - Phone:323-409-5126
Practice Address - Fax:323-441-8193
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program