Provider Demographics
NPI:1033136502
Name:OGDEN, ANDREW J (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:OGDEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3 LYON PLACE
Mailing Address - Street 2:STE 300
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-2546
Mailing Address - Country:US
Mailing Address - Phone:315-393-6186
Mailing Address - Fax:315-393-2639
Practice Address - Street 1:3 LYON PLACE
Practice Address - Street 2:STE 300
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-2546
Practice Address - Country:US
Practice Address - Phone:315-393-6186
Practice Address - Fax:315-393-2639
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-20
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Provider Licenses
StateLicense IDTaxonomies
NY189521207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01342658Medicaid
DD2520Medicare PIN
NY01342658Medicaid