Provider Demographics
NPI:1528680741
Name:DAVILA, ANDREA CAROLINA (DO)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAROLINA
Last Name:DAVILA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 CORTLANDT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3128
Mailing Address - Country:US
Mailing Address - Phone:973-759-1221
Mailing Address - Fax:973-759-1997
Practice Address - Street 1:195 CORTLANDT ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3128
Practice Address - Country:US
Practice Address - Phone:973-759-1221
Practice Address - Fax:973-759-1997
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11962300207Q00000X
PAOT020076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine