Provider Demographics
NPI:1366467607
Name:KUNDRAT, ANDREW (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KUNDRAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8356 SAND CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1087
Mailing Address - Country:US
Mailing Address - Phone:301-604-3416
Mailing Address - Fax:
Practice Address - Street 1:8356 SAND CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1087
Practice Address - Country:US
Practice Address - Phone:301-604-3416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036716207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
522096682004OtherTRICARE
MD209821100Medicaid
04-58254OtherEVERCARE
9680-0060OtherCAREFIRST BCBS OF DC
522888-03OtherCAREFIRST BCBS OF MD
522096682004OtherTRICARE
522888-03OtherCAREFIRST BCBS OF MD
B60990Medicare UPIN