Provider Demographics
NPI:1487671962
Name:MOSKOVITZ, ANDREW G (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:MOSKOVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2150 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3384
Mailing Address - Country:US
Mailing Address - Phone:860-741-6572
Mailing Address - Fax:860-253-9326
Practice Address - Street 1:2150 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3566
Practice Address - Country:US
Practice Address - Phone:413-739-5676
Practice Address - Fax:413-733-5860
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77152207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14580OtherHEALTH NEW ENGLAND
MAJ14675OtherBLUE CROSS BLUE SHIELD MA
MA077152OtherTUFTS HEALTH PLAN
CT010077152MA01OtherBLUE CROSS BLUE SHIELD CT
MA3113949Medicaid
CT010077152MA01OtherBLUE CROSS BLUE SHIELD CT
F84036Medicare UPIN