Provider Demographics
NPI:1215922182
Name:DILL, ANDREW B (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:DILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 FLORIDA MEMORIAL PKWY STE 2200
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9309
Mailing Address - Country:US
Mailing Address - Phone:386-409-6839
Mailing Address - Fax:
Practice Address - Street 1:125 FLORIDA MEMORIAL PKWY STE 2200
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-9309
Practice Address - Country:US
Practice Address - Phone:386-409-6839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42087207Q00000X
WAMD60491863207Q00000X
FLME163322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I48653Medicare UPIN