MEDICARE: MARAH LYNN ANDRADE PA-C

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
1	363A00000X	Physician Assistant		CA

General Provider Information

NPI Number	:	1518625995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARAH LYNN ANDRADE PA-C

Provider Business Mailing Address
First Line	:	1233 LOCUST ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5400
Country	:	US
Telephone Number	:	267-725-0252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 CHESTNUT ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4131
Country	:	US
Telephone Number	:	267-725-0252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	01/09/2026

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