Provider Demographics
NPI:1649335274
Name:DOUGLAS, ANDREW WALTER (RPA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:WALTER
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:304 W 148TH ST
Mailing Address - Street 2:APT 2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-2915
Mailing Address - Country:US
Mailing Address - Phone:570-660-7085
Mailing Address - Fax:
Practice Address - Street 1:3RD AVE AND 183RD STR
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2594
Practice Address - Country:US
Practice Address - Phone:718-960-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011617363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical