Healthcare Provider Details

I. General information

NPI: 1215652060
Provider Name (Legal Business Name): ANDREW NADERMANN MED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SOWERS ST STE 514
STATE COLLEGE PA
16801-5681
US

IV. Provider business mailing address

223 GWENEDD LN
PLEASANT GAP PA
16823-9614
US

V. Phone/Fax

Practice location:
  • Phone: 814-689-9466
  • Fax:
Mailing address:
  • Phone: 978-855-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: