Provider Demographics
NPI:1861587313
Name:LISS, ANDREW LANE (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LANE
Last Name:LISS
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1600 E GUDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1341
Mailing Address - Country:US
Mailing Address - Phone:301-933-7133
Mailing Address - Fax:301-933-7137
Practice Address - Street 1:10901 CONNECTICUT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1645
Practice Address - Country:US
Practice Address - Phone:301-949-2000
Practice Address - Fax:301-949-2002
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2018-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD4326213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD602278200Medicaid
MD330129YFCHMedicare PIN
T06627Medicare UPIN
DC330127YFCTMedicare PIN