Provider Demographics
NPI:1861415986
Name:KNOTT, ANDREW W (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:KNOTT
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 1:201 SIVLEY RD SW
Mailing Address - Street 2:SUITE 530
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5134
Mailing Address - Country:US
Mailing Address - Phone:256-265-7480
Mailing Address - Fax:256-265-7481
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:SUITE 530
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5134
Practice Address - Country:US
Practice Address - Phone:256-265-7480
Practice Address - Fax:256-265-7481
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL289012086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL126139Medicaid
MNP00391393OtherRAILROAD MEDICARE
AL511-11926OtherBCBS-AL
MN886613000Medicaid
AL126139Medicaid
MNP00391393OtherRAILROAD MEDICARE
AL102I775483Medicare PIN