Provider Demographics
NPI:1215961610
Name:KWONG, ANDREA
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:KWONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WYMAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2803
Mailing Address - Country:US
Mailing Address - Phone:410-338-3500
Mailing Address - Fax:
Practice Address - Street 1:6350 STEVENS FOREST RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3231
Practice Address - Country:US
Practice Address - Phone:410-715-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059332207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI29528Medicare UPIN
MD405294300Medicare ID - Type Unspecified