Provider Demographics
NPI:1881625440
Name:MASICA, ANDREW L (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:MASICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GASTON AVE
Mailing Address - Street 2:4 ROBERTS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2017
Mailing Address - Country:US
Mailing Address - Phone:214-820-3000
Mailing Address - Fax:214-820-3022
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:4 ROBERTS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-820-3000
Practice Address - Fax:214-820-3022
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4327207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187178201Medicaid
TX187178202Medicaid
TX8A0789OtherBCBS
TX8CZ871OtherBCBSTX
P01291021OtherPALMETTO/TRICARE
H82417Medicare UPIN
P01291021OtherPALMETTO/TRICARE
TXTXB132515Medicare PIN