Provider Demographics
NPI:1528300977
Name:LIMPUANGTHIP, ANDREA (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LIMPUANGTHIP
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 1:301 ST PAUL PLACE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-332-9844
Mailing Address - Fax:410-332-9134
Practice Address - Street 1:301 ST PAUL PLACE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-332-9844
Practice Address - Fax:410-332-9134
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD460948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033158480001Medicaid
PA578336OtherMEDICARE