Provider Demographics
NPI:1033294145
Name:DORY, ANDREA C (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:DORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2306
Mailing Address - Country:US
Mailing Address - Phone:718-842-8040
Mailing Address - Fax:718-842-8394
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE #250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:877-284-8933
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY232732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400015545Medicare PIN
NYA400025516Medicare PIN