Provider Demographics
NPI:1801917471
Name:ANDREA D. PEDANO, D.O., P.C.
Entity type:Organization
Organization Name:ANDREA D. PEDANO, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEDANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-487-1887
Mailing Address - Street 1:5458 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3732
Mailing Address - Country:US
Mailing Address - Phone:215-487-1887
Mailing Address - Fax:215-487-1818
Practice Address - Street 1:5458 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3732
Practice Address - Country:US
Practice Address - Phone:215-487-1887
Practice Address - Fax:215-487-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 008075 L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty