Provider Demographics
NPI:1952492878
Name:WELLMAN, ANDREW STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:STEPHEN
Last Name:WELLMAN
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 1:2175 N ALMA SCHOOL RD
Mailing Address - Street 2:A104
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2878
Mailing Address - Country:US
Mailing Address - Phone:480-969-7444
Mailing Address - Fax:480-969-1870
Practice Address - Street 1:2175 N ALMA SCHOOL RD
Practice Address - Street 2:A104
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2878
Practice Address - Country:US
Practice Address - Phone:480-969-7444
Practice Address - Fax:480-969-1870
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26460601Medicaid
AZD00546Medicare UPIN