Provider Demographics
NPI:1780804401
Name:SUCHOCKI, ANDREW GARY (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GARY
Last Name:SUCHOCKI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2051 KAEN RD STE 367
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-742-5300
Mailing Address - Fax:503-742-5979
Practice Address - Street 1:1425 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4076
Practice Address - Country:US
Practice Address - Phone:503-655-8471
Practice Address - Fax:503-723-4946
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35092730207Q00000X
KY43003207Q00000X
ORMD165025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3068899Medicaid
OH35-092730OtherOHIO MEDICAL LICENSE
OH35-092730OtherOHIO MEDICAL LICENSE
OH35-092730OtherOHIO MEDICAL LICENSE
KY00640025Medicare PIN
KY0637775Medicare PIN