Provider Demographics
NPI:1447283304
Name:FOX, ANDREA ROSE (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ROSE
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 BROWNS HILL RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2917
Mailing Address - Country:US
Mailing Address - Phone:412-422-7442
Mailing Address - Fax:412-904-5025
Practice Address - Street 1:4516 BROWNS HILL RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2917
Practice Address - Country:US
Practice Address - Phone:412-422-7442
Practice Address - Fax:412-904-5025
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044685L207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1259101Medicaid
PAA59920Medicare UPIN
PA1259101Medicaid