Provider Demographics
NPI:1942261490
Name:ANDRADE, JORGE M (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:M
Last Name:ANDRADE
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 1:851 MIDDLE ST
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1778
Mailing Address - Country:US
Mailing Address - Phone:508-235-5400
Mailing Address - Fax:508-235-5477
Practice Address - Street 1:851 MIDDLE ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1778
Practice Address - Country:US
Practice Address - Phone:508-235-5400
Practice Address - Fax:508-235-5477
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80436193400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No193400000XGroupSingle Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3154955Medicaid
MAJ14983Medicare PIN
MA3154955Medicaid
MAF97165Medicare UPIN