MEDICARE: ANDREW CHARLES PARKER M.D.

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	207P00000X	Emergency Medicine Physician	MT196763	PA
2	207P00000X	Emergency Medicine Physician	0101254415	VA

General Provider Information

NPI Number	:	1265750111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW CHARLES PARKER M.D.

Provider Business Mailing Address
First Line	:	3002 FOREST COVE DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2032
Country	:	US
Telephone Number	:	757-472-5892
Fax Number	:

Provider Business Practice Location Address
First Line	:	3002 FOREST COVE DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2032
Country	:	US
Telephone Number	:	757-472-5892
Fax Number	:

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

Provider Enumeration Date	:	05/16/2010
Last Update Date	:	08/14/2013

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