Provider Demographics
NPI:1891853859
Name:ANDRADA, ELIZABETH C (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:C
Last Name:ANDRADA
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 1:5 ALUMNI DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2128
Mailing Address - Country:US
Mailing Address - Phone:603-580-6793
Mailing Address - Fax:603-580-7006
Practice Address - Street 1:5 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2128
Practice Address - Country:US
Practice Address - Phone:603-580-6793
Practice Address - Fax:603-580-7006
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEEC-05-052207P00000X
NH13813207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207908Medicaid
ME433007799Medicaid
NHAA121060OtherHARVARD
MA2155796Medicaid
NH3743753OtherCIGNA
NH1891853859OtherANTHEM BC BS
NHP00647521OtherRAILROAD MEDICARE
NH30207908Medicaid