MEDICARE: ANDREA L ARCHER DO

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	0102201422	VA

General Provider Information

NPI Number	:	1669461356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA L ARCHER DO

Provider Business Mailing Address
First Line	:	38935 ANN ARBOR RD
Second Line	:	CREDENTIALING DEPT.
City	:	LIVONIA
State	:	MI
Zip	:	48150-3397
Country	:	US
Telephone Number	:	800-465-6052
Fax Number	:	301-921-7915

Provider Business Practice Location Address
First Line	:	13710 ST FRANCIS BLVD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-3267
Country	:	US
Telephone Number	:	804-594-7950
Fax Number	:	804-594-7955

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	12/05/2013

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