Provider Demographics
NPI:1225146848
Name:DANDREA, RONALD JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOSEPH
Last Name:DANDREA
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 1:51 DEPOT STREET
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795
Mailing Address - Country:US
Mailing Address - Phone:860-274-5497
Mailing Address - Fax:860-945-9054
Practice Address - Street 1:51 DEPOT STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795
Practice Address - Country:US
Practice Address - Phone:860-274-5497
Practice Address - Fax:860-945-9054
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTAD017531207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0236236003OtherCIGNA
CT010017531CV01OtherBS
P2654389OtherOXFORD
00117531400OtherBLUECARE FAMILY HUSKY
175310OtherCONNECTICARE
534574OtherAETNA
OR0805OtherHEALTHNET
B83329Medicare UPIN