Provider Demographics
NPI:1730177643
Name:SCHELLENBERG, ANDREA (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SCHELLENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5622
Mailing Address - Country:US
Mailing Address - Phone:610-628-8372
Mailing Address - Fax:610-628-8648
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:BOX 689
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18105
Practice Address - Country:US
Practice Address - Phone:610-402-9080
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD063708L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018186200005OtherPA MEDICAID
PA881754OtherHIGHMARK
PA0881754OtherKEYSTONE CENTRAL
PA1128084OtherKEYSTONE MERCY
PA0791775000OtherINDEP. BLUE CROSS
PA01818620OtherGATEWAY
PA0000000124691OtherTHREE RIVERS
PA050076232OtherRAIL ROAD MEDICARE
PA1128084OtherAMERIHEALTH MERCY
PA0000000124691OtherTHREE RIVERS
PA01818620OtherGATEWAY