Healthcare Provider Details

I. General information

NPI: 1992788129
Provider Name (Legal Business Name): ANDREA WILSON MEAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA L MEAD MD

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E 15TH ST
LOVELAND CO
80538-8938
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE STE 330
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-313-2700
  • Fax: 970-313-2727
Mailing address:
  • Phone: 970-313-2700
  • Fax: 970-313-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37043
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0037043
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: