Individual
ANDREA MARIE REQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5125 JONESTOWN RD STE 105, HARRISBURG, PA 17112-2987
(717) 943-1566
(717) 943-1567
Mailing address
PO BOX 758952, BALTIMORE, MD 21275-8952
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS007422E
PA
Other
Enumeration date
04/12/2006
Last updated
10/19/2016
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