Provider Demographics
NPI:1043228323
Name:SAYRE, ANDREW J (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:SAYRE
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 1:32-36 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1840
Mailing Address - Country:US
Mailing Address - Phone:570-723-0140
Mailing Address - Fax:570-724-6541
Practice Address - Street 1:32-36 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1840
Practice Address - Country:US
Practice Address - Phone:570-723-0140
Practice Address - Fax:570-724-6541
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022289E207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
80170904OtherRAILROAD MEDICARE
PASA40303OtherBLUE CROSS/BLUE SH NEPA
PA0009528010001Medicaid
PA0009528010001Medicaid
SA40303Medicare ID - Type Unspecified