Basic Information
| Provider Information | |||||||||
| NPI: | 1447256326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEHNKE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2215 LANDOVER PL | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245012115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349473944 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2215 LANDOVER PL | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349473944 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD042712L | PA | N | Other Service Providers | Specialist | 207RE0101X | 0101264377 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 0000648722 | 01 | PA | KEYSTONE | OTHER | 0001385966 | 01 | PA | BLUE CROSS/BLUE SHIELD | OTHER | 186646 | 01 | PA | HEALTH AMERICA | OTHER | 0015002450006 | 05 | PA | MEDICAID | 4609312 | 01 | PA | AETNA US HEALTHCARE | OTHER | 2951411 | 01 | PA | AETNA US HEALTHCARE/ HMO | OTHER | 50000721 | 01 | PA | CAPITAL BLUE CROSS | OTHER |