Provider Demographics
NPI:1740281674
Name:MCANDREW, MARK R (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:MCANDREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:368 BIELBY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2774
Practice Address - Country:US
Practice Address - Phone:812-537-5772
Practice Address - Fax:812-537-3936
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076656M208600000X
IN01050466A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200228410Medicaid
1512442001OtherCIGNA
2180111OtherAETNA
N50466OtherHUMANA CHOICECARE
000000065468OtherANTHEM
IN116307OtherANTHEM MEDICAID MCO
1701603OtherUNITED HEALTHCARE
OH4014281Medicare PIN
000000065468OtherANTHEM
1512442001OtherCIGNA
INM400059349Medicare PIN
IN116307OtherANTHEM MEDICAID MCO