Provider Demographics
NPI:1487071437
Name:KORCAL, ANDREW SCOTT (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:KORCAL
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 1:1085 BEECHER XING N STE A
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4563
Mailing Address - Country:US
Mailing Address - Phone:614-741-8300
Mailing Address - Fax:614-741-8271
Practice Address - Street 1:1085 BEECHER XING N STE A
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4563
Practice Address - Country:US
Practice Address - Phone:614-741-8300
Practice Address - Fax:614-741-8271
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-129376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0213075Medicaid