Provider Demographics
NPI:1699094342
Name:DOUD, ANDREA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:DOUD
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 1:231 E. CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:313-570-7077
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE J201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1821
Practice Address - Country:US
Practice Address - Phone:859-218-2522
Practice Address - Fax:859-323-3918
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY498952086S0102X, 2086S0120X
NC165395390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program