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NPI Code Detail

MEDICARE: DR. STACY ANDREWS M.D.

MEDICARE: DR. STACY ANDREWS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistD0059774MD

General Provider Information

NPI Number : 1215919972
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY ANDREWS M.D.
Provider Business Mailing Address
First Line : 4100 MASSACHUSETTS AVE NW
Second Line : 1412
City : WASHINGTON
State : DC
Zip : 20016-4757
Country : US
Telephone Number : 301-414-2300
Fax Number : 301-414-2306
Provider Business Practice Location Address
First Line : 26005 RIDGE RD
Second Line : 200
City : DAMASCUS
State : MD
Zip : 20872-1892
Country : US
Telephone Number : 301-414-2300
Fax Number : 301-414-2306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 06/11/2009

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