Provider Demographics
NPI:1992788129
Name:MEAD, ANDREA WILSON (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:WILSON
Last Name:MEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 330
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-313-2700
Mailing Address - Fax:970-313-2727
Practice Address - Street 1:3520 E 15TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8938
Practice Address - Country:US
Practice Address - Phone:970-313-2700
Practice Address - Fax:970-313-2727
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37043208000000X
CODR.0037043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0731497Medicaid
CO01370436Medicaid
COWI99334OtherANTHEM BCBS
CO01370436Medicaid
COH78909Medicare UPIN
CO01370436Medicaid