Provider Demographics
NPI:1326676172
Name:VAN DER VAART, ANDREW DONALD (MD, PHD)
Entity type:Individual
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First Name:ANDREW
Middle Name:DONALD
Last Name:VAN DER VAART
Suffix:
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:849 FAIRMOUNT AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2624
Mailing Address - Country:US
Mailing Address - Phone:443-377-5273
Mailing Address - Fax:
Practice Address - Street 1:6501 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00949032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry