Provider Demographics
NPI:1689787368
Name:YUAN, ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 POST ROAD
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824
Mailing Address - Country:US
Mailing Address - Phone:203-256-4733
Mailing Address - Fax:203-256-4736
Practice Address - Street 1:1735 POST RD
Practice Address - Street 2:SUITE # 7
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5782
Practice Address - Country:US
Practice Address - Phone:203-256-4733
Practice Address - Fax:203-256-4736
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000314208100000X
NY183476-1208100000X
OH34 . 005275208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT040000314CT02OtherANTHEM BC/BS
E95391Medicare UPIN
CT250000246Medicare ID - Type Unspecified