Provider Demographics
NPI:1861459125
Name:LAWSON, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:LAWSON
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 1:134 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-756-8911
Mailing Address - Fax:203-574-0548
Practice Address - Street 1:134 GRANDVIEW AVE
Practice Address - Street 2:STE 101
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-756-8911
Practice Address - Fax:203-574-0548
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0390072085R0202X
CT0370072085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
010034007CT01OtherANTHEM
0R0365OtherHEALTHNET
CT001340075CTMedicaid
711609OtherCT CARE
A437740OtherOXFORD
010034007CT01OtherANTHEM
G05005Medicare UPIN