Provider Demographics
NPI:1609858026
Name:NOWAKOWSKI, ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:NOWAKOWSKI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PLUMTREE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6095
Mailing Address - Country:US
Mailing Address - Phone:410-515-4300
Mailing Address - Fax:410-601-1052
Practice Address - Street 1:104 PLUMTREE RD STE 115
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6095
Practice Address - Country:US
Practice Address - Phone:410-515-4300
Practice Address - Fax:410-601-1052
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152340207RN0300X
MDD0008096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC49275Medicare UPIN
MD6459Medicare ID - Type Unspecified