Provider Demographics
NPI:1831214774
Name:ANDREW BROBBEY MD INC
Entity type:Organization
Organization Name:ANDREW BROBBEY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROBBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-731-7110
Mailing Address - Street 1:PO BOX 22958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0958
Mailing Address - Country:US
Mailing Address - Phone:216-731-7110
Mailing Address - Fax:216-731-7130
Practice Address - Street 1:27900 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3539
Practice Address - Country:US
Practice Address - Phone:216-731-7110
Practice Address - Fax:216-731-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083527B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH077098726026OtherCARESOURCE
OHDP2284OtherRAILROAD MEDICARE
OH000000359486OtherANTHEM BLUE CROSS
OH3001334Medicaid
OH077908726005OtherMEDICAL MUTUAL OF OHIO
OH000000359486OtherANTHEM BLUE CROSS
OHI04261Medicare UPIN