Provider Demographics
NPI:1871774349
Name:ANDREW M. LONDON MD,PA
Entity type:Organization
Organization Name:ANDREW M. LONDON MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-5863
Mailing Address - Street 1:1300 YORK RD
Mailing Address - Street 2:BLDG A, SUITE 100
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6000
Mailing Address - Country:US
Mailing Address - Phone:410-296-5863
Mailing Address - Fax:410-296-3105
Practice Address - Street 1:1300 YORK RD
Practice Address - Street 2:BLDG A, SUITE 100
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6000
Practice Address - Country:US
Practice Address - Phone:410-296-5863
Practice Address - Fax:410-296-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD7566OtherRAILROAD MEDICARE GROUP ID
MD109PMedicare PIN