Provider Demographics
NPI:1063445161
Name:GUEST, ANDREW D (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:GUEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489
Mailing Address - Country:US
Mailing Address - Phone:860-628-0343
Mailing Address - Fax:860-628-0543
Practice Address - Street 1:171 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-628-0343
Practice Address - Fax:860-628-0543
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT21400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001214006Medicaid
110000948Medicare ID - Type Unspecified
B84584Medicare UPIN