MEDICARE: DR. ANDREA KRICHELLE BALTHAZAR 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	208800000X	Urology Physician	283724	MA
2	2088P0231X	Pediatric Urology Physician	U3781	TX
3	208800000X	Urology Physician	U3781	TX
4	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922495738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA KRICHELLE BALTHAZAR M.D.

Provider Business Mailing Address
First Line	:	1301 BARBARA JORDAN BLVD STE 302
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3078
Country	:	US
Telephone Number	:	512-324-3042
Fax Number	:	512-324-3059

Provider Business Practice Location Address
First Line	:	1301 BARBARA JORDAN BLVD STE 302
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3078
Country	:	US
Telephone Number	:	512-324-3042
Fax Number	:	512-324-3059

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

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	02/15/2026

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