Provider Demographics
NPI:1104894252
Name:SOTELO, ANDREA KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:KATHLEEN
Last Name:SOTELO
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 1:103 CONTINENTAL PL
Mailing Address - Street 2:STE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1041
Mailing Address - Country:US
Mailing Address - Phone:615-916-3200
Mailing Address - Fax:615-658-8389
Practice Address - Street 1:6116 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5703
Practice Address - Country:US
Practice Address - Phone:303-512-0888
Practice Address - Fax:303-512-2268
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42674207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0156791Medicaid
NM83357076Medicaid
UTZ2990Medicaid
MN425420100Medicaid
CO03106322Medicaid
NM83357076Medicaid
COP00316649Medicare PIN
MT0156791Medicaid