Provider Demographics
NPI:1700059896
Name:SCOTT E ANDOCHICK MD PA
Entity type:Organization
Organization Name:SCOTT E ANDOCHICK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDOCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-620-4200
Mailing Address - Street 1:81 THOMAS JOHNSON CT STE A
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4348
Mailing Address - Country:US
Mailing Address - Phone:301-620-4200
Mailing Address - Fax:301-620-0879
Practice Address - Street 1:81 THOMAS JOHNSON CT STE A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4348
Practice Address - Country:US
Practice Address - Phone:301-620-4200
Practice Address - Fax:301-620-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
634RMedicare PIN