Provider Demographics
NPI:1255503769
Name:DAVIDSON, ANDREW C (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19 WOODLAND ST
Mailing Address - Street 2:SUITE 35
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2372
Mailing Address - Country:US
Mailing Address - Phone:860-525-1234
Mailing Address - Fax:860-278-8782
Practice Address - Street 1:19 WOODLAND ST
Practice Address - Street 2:SUITE 35
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2372
Practice Address - Country:US
Practice Address - Phone:860-525-1234
Practice Address - Fax:860-278-8782
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2017-05-05
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Provider Licenses
StateLicense IDTaxonomies
CT52639207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400135476Medicare PIN