MEDICARE: DR. KENNETH A. ANDREONI 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	204F00000X	Transplant Surgery Physician	35071275	OH
2	208600000X	Surgery Physician	ME113599	FL
3	208600000X	Surgery Physician	9901500	NC
4	204F00000X	Transplant Surgery Physician	MD480153	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780778035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A. ANDREONI M.D.

Provider Business Mailing Address
First Line	:	1025 WALNUT ST BLDG 605
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5001
Country	:	US
Telephone Number	:	352-443-0994
Fax Number	:	215-923-1420

Provider Business Practice Location Address
First Line	:	1025 WALNUT ST BLDG 605
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5001
Country	:	US
Telephone Number	:	352-443-0994
Fax Number	:	215-923-1420

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/20/2024

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Directions to “ DR. KENNETH A. ANDREONI M.D.” Practice Location

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