Provider Demographics
NPI:1902931074
Name:ANDRUS, WILLIAM CHRISTOPHER (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHRISTOPHER
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 STUDENT HEALTH CTR
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802-2129
Mailing Address - Country:US
Mailing Address - Phone:814-865-4847
Mailing Address - Fax:814-865-7778
Practice Address - Street 1:308 STUDENT HEALTH CTR
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-2129
Practice Address - Country:US
Practice Address - Phone:814-865-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062241363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV5030DMedicare PIN
VAVV5030CMedicare PIN
VAVV5030BMedicare PIN