Provider Demographics
NPI:1962430108
Name:MORGAN, ANDREW MARLIN (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARLIN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N TWIN CREEK DR
Mailing Address - Street 2:#201
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-4268
Mailing Address - Country:US
Mailing Address - Phone:443-622-3234
Mailing Address - Fax:
Practice Address - Street 1:1001 N TWIN CREEK DR
Practice Address - Street 2:#201
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-4268
Practice Address - Country:US
Practice Address - Phone:443-622-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60090207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH08838Medicare UPIN
MD157676Medicare PIN
MDH596E963Medicare PIN
MD070017367Medicare PIN