Provider Demographics
NPI:1356305171
Name:ANDREYEVA, OLGA I (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:I
Last Name:ANDREYEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SAINT MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7601
Mailing Address - Country:US
Mailing Address - Phone:505-913-6130
Mailing Address - Fax:
Practice Address - Street 1:455 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7601
Practice Address - Country:US
Practice Address - Phone:505-913-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206648207R00000X
NMMD2013-0072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000008340OtherPROVIDER HEALTHNET NUMBER
MA3968488OtherPROVIDER AETNA NUMBER
MA1745138001OtherPROVIDER CIGNA NUMBER
MA2132966Medicaid
MAJ23355OtherBC/BS
MA1310097Medicaid
MA975513OtherPROVIDER NETWORK HEALTH #
MAMA0423703AOtherPROVIDER CSR #
MA691829OtherPROVIDER HARVARD PILGRIM
206648OtherPROVIDER CONNECTICARE #
MA0023361OtherPROVIDER NHP NUMBER
MA206648OtherPROVIDE LICENSE #
MA206648OtherPROVIDE LICENSE #
MA2132966Medicaid
P00379292Medicare PIN
206648OtherPROVIDER CONNECTICARE #
MA1310097Medicaid