1356305171 NPI number — DR. OLGA I ANDREYEVA MD

Table of content: DR. OLGA I ANDREYEVA MD (NPI 1356305171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356305171 NPI number — DR. OLGA I ANDREYEVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREYEVA
Provider First Name:
OLGA
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1356305171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 SAINT MICHAELS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-7601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-913-6130
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 SAINT MICHAELS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-913-6130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  206648 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD2013-0072 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000008340 . This is a "PROVIDER HEALTHNET NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3968488 . This is a "PROVIDER AETNA NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1745138001 . This is a "PROVIDER CIGNA NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2132966 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J23355 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1310097 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 975513 . This is a "PROVIDER NETWORK HEALTH #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: MA0423703A . This is a "PROVIDER CSR #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 691829 . This is a "PROVIDER HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 206648 . This is a "PROVIDER CONNECTICARE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0023361 . This is a "PROVIDER NHP NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 206648 . This is a "PROVIDE LICENSE #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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