Provider Demographics
NPI:1861601114
Name:ANDROVICH CHAVARRY, PATRICIA ANN (DO)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:ANDROVICH CHAVARRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 STONE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-8211
Mailing Address - Country:US
Mailing Address - Phone:302-535-4786
Mailing Address - Fax:
Practice Address - Street 1:492 STONE RIDGE DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-8211
Practice Address - Country:US
Practice Address - Phone:302-535-4786
Practice Address - Fax:302-535-4786
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0008573207RG0300X
NJ25MB05808900207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7277202Medicaid
NJAN002081Medicare ID - Type Unspecified
NJ7277202Medicaid