Provider Demographics
NPI:1780221556
Name:DEGROAT, ANDREW M
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:DEGROAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2030
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-6804
Mailing Address - Country:US
Mailing Address - Phone:540-455-0064
Mailing Address - Fax:
Practice Address - Street 1:4420 TWILIGHT LN
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22551-3004
Practice Address - Country:US
Practice Address - Phone:540-455-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-29
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA82-4616173OtherIRS