Provider Demographics
NPI:1942462007
Name:GALASSO, ANDREA JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JEAN
Last Name:GALASSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BUTTRICK RD
Mailing Address - Street 2:ELLIOT INTERNAL MEDICINE AT LONDONDERRY
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3381
Mailing Address - Country:US
Mailing Address - Phone:603-434-1919
Mailing Address - Fax:603-434-7346
Practice Address - Street 1:40 BUTTRICK RD
Practice Address - Street 2:ELLIOT INTERNAL MEDICINE AT LONDONDERRY
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3381
Practice Address - Country:US
Practice Address - Phone:603-434-1919
Practice Address - Fax:603-434-7346
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242853207R00000X, 207RG0300X, 208M00000X
VT032.0047319207R00000X, 207RG0300X, 208M00000X
NH16477207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075145Medicaid
NH3075145Medicaid