Provider Demographics
NPI:1306987409
Name:METKUS, ANDREA P (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:P
Last Name:METKUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-652-8788
Mailing Address - Fax:
Practice Address - Street 1:50 S. SAN MATEO
Practice Address - Street 2:SUITE 360
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94401-3857
Practice Address - Country:US
Practice Address - Phone:650-342-9491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75018208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75018OtherLICENSE
CAYYY34803YMedicaid
CAG75018OtherLICENSE
CAZZZ38666ZMedicare ID - Type Unspecified