Provider Demographics
NPI:1699725432
Name:PEDANO, ANDREA D (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:D
Last Name:PEDANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5458 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3732
Mailing Address - Country:US
Mailing Address - Phone:215-487-1887
Mailing Address - Fax:215-487-1818
Practice Address - Street 1:5458 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3732
Practice Address - Country:US
Practice Address - Phone:215-487-1887
Practice Address - Fax:215-487-1818
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008075L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001494970Medicaid
PA1050839OtherKEYSTONE MERCY
PA1159711009OtherCIGNA
PA1464OtherELDERHEALTH
PA500763OtherBLUE CROSS/BLUE SHIELD
PA0808997OtherAETNA
PA2290076001OtherKEYSTONE
PA40481OtherAETNA- USHC
PA1050839OtherKEYSTONE MERCY
PA001494970Medicaid