Provider Demographics
NPI:1679537187
Name:ANDOLA, ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:ANDOLA
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 1:35 BARBAROSSA LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1221
Mailing Address - Country:US
Mailing Address - Phone:845-338-3737
Mailing Address - Fax:845-338-3939
Practice Address - Street 1:35 BARBAROSSA LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1221
Practice Address - Country:US
Practice Address - Phone:845-338-3737
Practice Address - Fax:845-338-3939
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215240-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53150OtherGHI HMO INSURANCE
NY10049755OtherCDPHP
NY02109924Medicaid
NY000498013002OtherBLUE SHIELD NORTHEASTERN
NY087306OtherMVP HEALTH PLANS
NYP2718492OtherOXFORD HEALTH PLANS
NY37V801OtherEMPIRE BC/BS
NY0D3671Medicare ID - Type UnspecifiedMEDICARE
NY10049755OtherCDPHP