Provider Demographics
NPI:1275509168
Name:GIANNOTTI, ANDREW G (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:G
Last Name:GIANNOTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:410 5TH AVE SW UNIT 313
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9474 LATHROP INDUSTRIAL DR SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-1109
Practice Address - Country:US
Practice Address - Phone:360-583-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD615089692083A0300X
TXM7991207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8311433Medicaid
OR286900Medicaid
TX8CD191OtherBLUE CROSS BLUE SHIELD
OR050088489OtherRR MEDICARE
TXP00797255OtherMEDICARE RAILROAD
H60851Medicare UPIN
TXP00797255OtherMEDICARE RAILROAD
TX8CD191OtherBLUE CROSS BLUE SHIELD