Individual ProviderAndrea McdonoughPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3401 Civic Center Blvd, Philadelphia, PA 19104(610) 405-4477PECOS EnrollmentBased on the most recent information from CMS, provider Andrea Mcdonough does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1992180152Provider TypeIndividualFull NameMcdonough, AndreaCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date7/29/2015Last Updated12/23/2019Contact InformationPractice LocationPractice Address3401 Civic Center Blvd, Philadelphia, PA 19104Phone(610) 405-4477FaxUnlisted FaxMailing LocationMailing Address3401 Civic Center Blvd, Philadelphia, PA 19104-4319PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363AM0700XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseMA057694Pennsylvania