Provider Demographics
NPI:1912150541
Name:ANDREW NOWAKOWSKI, M.D., P.A.
Entity Type:Organization
Organization Name:ANDREW NOWAKOWSKI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-838-8900
Mailing Address - Street 1:35 FULFORD AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3938
Mailing Address - Country:US
Mailing Address - Phone:410-838-8900
Mailing Address - Fax:410-838-1767
Practice Address - Street 1:35 FULFORD AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3938
Practice Address - Country:US
Practice Address - Phone:410-838-8900
Practice Address - Fax:410-838-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0008096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty