Provider Demographics
NPI:1164447785
Name:GUTIERREZ, ANDREA M (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 ROYCE CIR STE 104
Mailing Address - Street 2:UCONN MEDICAL GROUP
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2270
Mailing Address - Country:US
Mailing Address - Phone:860-487-9200
Mailing Address - Fax:860-487-9222
Practice Address - Street 1:1 ROYCE CIR STE 104
Practice Address - Street 2:UCONN MEDICAL GROUP
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2270
Practice Address - Country:US
Practice Address - Phone:860-487-9200
Practice Address - Fax:860-487-9222
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT041670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001416701Medicaid
CT080001652Medicare ID - Type Unspecified
CTI01853Medicare UPIN