Provider Demographics
NPI:1649279167
Name:WORMSER, ANDREW (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WORMSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9 WASHINGTON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3267
Mailing Address - Country:US
Mailing Address - Phone:203-248-3013
Mailing Address - Fax:203-248-2878
Practice Address - Street 1:46 PRINCE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1600
Practice Address - Country:US
Practice Address - Phone:203-772-0011
Practice Address - Fax:203-785-9352
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT1266238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0Q2059OtherHEALTH NET
CT110158519OtherRAILROAD MEDICARE
CT2047739OtherAETNA
CT726623OtherCONNECTICARE
CTNHP073OtherOXFORD
CT010026623CT01OtherBLUE CROSS BLUE SHIELD
CT110158519OtherRAILROAD MEDICARE
CT0Q2059OtherHEALTH NET