Provider Demographics
NPI:1689656613
Name:SZCZEPANSKI, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SZCZEPANSKI
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 1:115 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1140
Mailing Address - Country:US
Mailing Address - Phone:860-379-3339
Mailing Address - Fax:860-379-2269
Practice Address - Street 1:115 SPENCER ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-1140
Practice Address - Country:US
Practice Address - Phone:860-379-3339
Practice Address - Fax:860-379-2269
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G98443Medicare UPIN
CT110007662Medicare ID - Type Unspecified