Provider Demographics
NPI:1376947432
Name:MCDOWELL, ANDREW J (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONG WHARF DR
Mailing Address - Street 2:SUIT 212
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5991
Mailing Address - Country:US
Mailing Address - Phone:203-624-4208
Mailing Address - Fax:203-624-4301
Practice Address - Street 1:1 LONG WHARF DR
Practice Address - Street 2:SUIT 212
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5991
Practice Address - Country:US
Practice Address - Phone:203-624-4208
Practice Address - Fax:203-624-4301
Is Sole Proprietor?:No
Enumeration Date:2014-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3220363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCSP0058906OtherCONTROLLED SUBSTANCE REGISTRATION
CT003220OtherSTATE OF CT LICESNSE
CT003220OtherSTATE OF CT LICESNSE