Provider Demographics
NPI:1295799153
Name:ROTSIDES, ANDREAS D (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREAS
Middle Name:D
Last Name:ROTSIDES
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 1:195 US HIGHWAY 46
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3163
Mailing Address - Country:US
Mailing Address - Phone:973-328-1040
Mailing Address - Fax:973-328-1544
Practice Address - Street 1:195 US HIGHWAY 46
Practice Address - Street 2:SUITE 200
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803-3163
Practice Address - Country:US
Practice Address - Phone:973-328-1040
Practice Address - Fax:973-328-1544
Is Sole Proprietor?:No
Enumeration Date:2006-04-16
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05010400207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0103161000OtherAMERIHEALTH PROVIDER ID
NJ0858096OtherCIGNA PROVIDER ID
NJP00197592OtherRAILROAD MEDICARE ID
NJP3617003OtherOXFORD PROVIDER ID
NJ00012211007OtherUNITED HEALTHCARE ID
NJ1147200Medicaid
NJ2K8102OtherHEALTHNET PROVIDER ID
NJ494819OtherAETNA PROVIDER ID
NJ0103161000OtherAMERIHEALTH PROVIDER ID
NJ1147200Medicaid