Provider Demographics
NPI:1548360191
Name:HUANG, ANDREW B (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 COOSA ST E
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2276
Mailing Address - Country:US
Mailing Address - Phone:256-362-3636
Mailing Address - Fax:256-362-0027
Practice Address - Street 1:320 COOSA ST E
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2276
Practice Address - Country:US
Practice Address - Phone:256-362-3636
Practice Address - Fax:256-362-0027
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000038904Medicaid
AL38904Medicare ID - Type Unspecified
AL000038904Medicaid