Provider Demographics
NPI:1801989165
Name:BUSH, ANDREA WICK (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:WICK
Last Name:BUSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ARLENE
Other - Last Name:WICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5530 WISCONSIN AVE STE 1660
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4322
Mailing Address - Country:US
Mailing Address - Phone:301-657-9876
Mailing Address - Fax:301-657-8229
Practice Address - Street 1:5530 WISCONSIN AVE STE 1660
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4322
Practice Address - Country:US
Practice Address - Phone:301-657-9876
Practice Address - Fax:301-657-8229
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030404363AS0400X
MDC0003208363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02237M02Medicare ID - Type Unspecified