Provider Demographics
NPI:1376500926
Name:VANDERZANDEN, ANDRE H (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:H
Last Name:VANDERZANDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1187 SALMON FALLS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03868-5722
Mailing Address - Country:US
Mailing Address - Phone:603-742-4048
Mailing Address - Fax:603-743-3345
Practice Address - Street 1:17 OLD ROLLINSFORD RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2827
Practice Address - Country:US
Practice Address - Phone:603-742-4048
Practice Address - Fax:603-743-3345
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH5196208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000525Medicaid
NH20114YOtherANTHEM PROVIDER #
NH8882667-001OtherCIGNA
NHNH1043OtherHARVARD PILGRAM PROVIDER
NH7114333OtherAETNA PROVIDER #