Provider Demographics
NPI:1366709255
Name:MABRY, ANDREA GREEN (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:GREEN
Last Name:MABRY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:16115 SAINT VINCENT WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3000
Mailing Address - Country:US
Mailing Address - Phone:501-420-3376
Mailing Address - Fax:501-817-3930
Practice Address - Street 1:16115 SAINT VINCENT WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-3000
Practice Address - Country:US
Practice Address - Phone:501-420-3376
Practice Address - Fax:501-817-3930
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2016-07-07
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Provider Licenses
StateLicense IDTaxonomies
ARE-8321207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR507243Medicare PIN