# ANDREA MERNITZ

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1962460964
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1051166 | IN | Yes |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 09/06/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000089944 | BLUE CROSS ANTHEM | IN |
| 01 | — | 000000984082 | ANTHEM PIN | IN |
| 01 | — | 080141548 | MEDICARE RAILROAD | IN |
| 01 | — | 1051166 | IN MEDICAL LICENSE | IN |
| 05 | — | 200229670A | — | IN |