Provider Demographics
NPI:1437126133
Name:ATKINSON, ANDREW M (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:ATKINSON
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 1:2222 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5594
Mailing Address - Country:US
Mailing Address - Phone:321-541-1714
Mailing Address - Fax:321-676-9794
Practice Address - Street 1:2222 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5594
Practice Address - Country:US
Practice Address - Phone:321-541-1714
Practice Address - Fax:321-676-9794
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110062397OtherRAIL ROAD MEDICARE
FL061987600Medicaid
FL08672XMedicare ID - Type Unspecified
FL061987600Medicaid