Provider Demographics
NPI:1780770206
Name:LONDON, ANDREW M (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:LONDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 YORK RD
Mailing Address - Street 2:BUILDING A SUITE 100
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6016
Mailing Address - Country:US
Mailing Address - Phone:410-296-5863
Mailing Address - Fax:410-583-9120
Practice Address - Street 1:1300 YORK RD
Practice Address - Street 2:BUILDING A SUITE 100
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6016
Practice Address - Country:US
Practice Address - Phone:410-296-5863
Practice Address - Fax:410-583-9120
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017049207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD7566OtherRAILROAD MEDICARE GROUP ID
P00249016OtherRAILROAD MEDICARE INDIV. ID
P00249016OtherRAILROAD MEDICARE INDIV. ID
DD7566OtherRAILROAD MEDICARE GROUP ID