Healthcare Provider Details

I. General information

NPI: 1821591926
Provider Name (Legal Business Name): ANDREW L. FOZZARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE C405
LEXINGTON KY
40504-1748
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-4429
  • Fax: 859-313-1095
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-313-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number55472
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number55472
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: