Provider Demographics
NPI:1942203690
Name:ROSENZWEIG, ANDREW SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SETH
Last Name:ROSENZWEIG
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 1:55 HATCHETTS HILL RD
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1534
Mailing Address - Country:US
Mailing Address - Phone:800-370-3651
Mailing Address - Fax:877-515-7147
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:RM. 232 2ND FLOOR ANNEX BUILDING
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-369-6515
Practice Address - Fax:401-273-9456
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT490702084P0805X
PAMD051072L2084P0805X
NJ25MA088839002084P0805X
RI098742084P0805X
MA2383902084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057693Medicaid
MA110083342AMedicaid
RIG19003Medicare UPIN
MA110083342AMedicaid
RI007059409Medicare PIN