Healthcare Provider Details

I. General information

NPI: 1033564828
Provider Name (Legal Business Name): ANDREW LUKAS CHOLEWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4885 DEMOSS RD STE 200
READING PA
19606-9025
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 610-898-5660
  • Fax: 610-779-8083
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA058131
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: