Provider Demographics
NPI:1619062940
Name:WOOLRICH, ANDREW GLEN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:GLEN
Last Name:WOOLRICH
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 1:140 EAST 80TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0306
Mailing Address - Country:US
Mailing Address - Phone:212-717-1684
Mailing Address - Fax:212-717-0410
Practice Address - Street 1:140 EAST 80TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0306
Practice Address - Country:US
Practice Address - Phone:212-717-1684
Practice Address - Fax:212-717-0410
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1836391207N00000X
NJ25MA06074900207N00000X
FLME67211207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
516381OtherAETNA
NS3706OtherOX FORD
OC3537OtherHEALTHNET
NJP685488OtherOXFORD
75H571OtherEMPIRE
NJ19795BOtherMAGNACARE
30664POtherHIP
NJ0516381OtherAETNA./USHC
NJ0K1302OtherHEALTHNET
NJ19795BOtherMAGNACARE
F62451Medicare UPIN
NJ428331Medicare PIN