Provider Demographics
NPI:1386879450
Name:PEARSON, ANDREA JOYCE (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOYCE
Last Name:PEARSON
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 1:11717 OLD NATIONAL PIKE STE 8
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6119
Mailing Address - Country:US
Mailing Address - Phone:301-882-7489
Mailing Address - Fax:301-882-7520
Practice Address - Street 1:11717 OLD NATIONAL PIKE STE 8
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774
Practice Address - Country:US
Practice Address - Phone:301-882-7489
Practice Address - Fax:301-882-7520
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2023-11-27
Deactivation Date:2021-02-02
Deactivation Code:
Reactivation Date:2021-03-04
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
DCMD040444208000000X
MDD0073961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health