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NPI Code Detail

MEDICARE: MADELINE ANDREW M.D.

MEDICARE: MADELINE ANDREW 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
12084P0800XPsychiatry PhysicianJ3276TX

General Provider Information

NPI Number : 1861619538
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE ANDREW M.D.
Provider Business Mailing Address
First Line : 401 N CARROLL AVE # 586
Second Line :
City : SOUTHLAKE
State : TX
Zip : 76092-6407
Country : US
Telephone Number : 415-480-9019
Fax Number :
Provider Business Practice Location Address
First Line : 511 E JOHN CARPENTER FWY STE 500
Second Line :
City : IRVING
State : TX
Zip : 75062-8138
Country : US
Telephone Number : 214-265-6565
Fax Number : 707-581-2020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 07/26/2023

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