1033231261 NPI number — ANDREW DL GUEST MD PC

Table of content: (NPI 1033231261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033231261 NPI number — ANDREW DL GUEST MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREW DL GUEST MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033231261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 LIBERTY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-628-0343
Provider Business Mailing Address Fax Number:
860-628-0543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-628-0343
Provider Business Practice Location Address Fax Number:
860-628-0543
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUEST
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
DL
Authorized Official Title or Position:
PRESIDENT ANDREW D L GUEST MD PC
Authorized Official Telephone Number:
860-628-0343

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  21400 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001214006 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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