MEDICARE: ANDREW WILLIAM KING MD

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	207Q00000X	Family Medicine Physician	MD045690L	PA
2	207QS0010X	Sports Medicine (Family Medicine) Physician	MD045690L	PA

General Provider Information

NPI Number	:	1497733653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW WILLIAM KING MD

Provider Business Mailing Address
First Line	:	3530 PEACH ST
Second Line	:	SUITE LL1
City	:	ERIE
State	:	PA
Zip	:	16508-2768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 N MAIN ST
Second Line	:
City	:	UNION CITY
State	:	PA
Zip	:	16438-1068
Country	:	US
Telephone Number	:	814-438-7208
Fax Number	:	814-438-8062

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/15/2007

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Directions to “ ANDREW WILLIAM KING MD” Practice Location

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