Provider Demographics
NPI:1801992680
Name:KNEPP, ANDREW MATTHEW (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MATTHEW
Last Name:KNEPP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1611 NW 12 AVENUE
Mailing Address - Street 2:UROLOGY DEPARTMENT
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-243-3670
Mailing Address - Fax:305-243-4653
Practice Address - Street 1:1410 LAUREL BLVD
Practice Address - Street 2:COMMUNITY BASED V.A. CLINIC
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901
Practice Address - Country:US
Practice Address - Phone:570-628-5374
Practice Address - Fax:570-628-5809
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA000075L363A00000X
PAMA000665L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA096980MK6Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER