Provider Demographics
NPI:1952578528
Name:ITSKOVICH, ANDREA CYNTHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:CYNTHIA
Last Name:ITSKOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 FANNING WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2204
Mailing Address - Country:US
Mailing Address - Phone:919-321-2682
Mailing Address - Fax:
Practice Address - Street 1:603 FANNING WAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2204
Practice Address - Country:US
Practice Address - Phone:919-321-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program