Provider Demographics
NPI:1285943688
Name:WIGGINS, ANDRIA MAXINE
Entity type:Individual
Prefix:MS
First Name:ANDRIA
Middle Name:MAXINE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:7842 SCOTLAND DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4063
Mailing Address - Country:US
Mailing Address - Phone:301-300-1674
Mailing Address - Fax:
Practice Address - Street 1:7711 GARRISON RD
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1756
Practice Address - Country:US
Practice Address - Phone:301-306-0099
Practice Address - Fax:301-306-0059
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-02
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC02990363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant