Provider Demographics
NPI:1194875781
Name:AHN, ANDREW H (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:H
Last Name:AHN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-5404
Mailing Address - Fax:352-376-6270
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-5404
Practice Address - Fax:352-376-6270
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA658212084N0400X
FLME1065392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A658210Medicaid
FL002161400Medicaid
FLDE421ZMedicare PIN
CAH54229Medicare UPIN
CA00A658210Medicare PIN