Provider Demographics
NPI:1841487725
Name:ANDINO GUARDERAS, JOSE FEDERICO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE FEDERICO
Middle Name:
Last Name:ANDINO GUARDERAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J. FEDERICO
Other - Middle Name:
Other - Last Name:ANDINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:1330 POWELL ST
Practice Address - Street 2:SUITE 409
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3353
Practice Address - Country:US
Practice Address - Phone:484-622-7510
Practice Address - Fax:484-622-7520
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441049207Q00000X
PAMT190383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine