Provider Demographics
NPI:1740266436
Name:MANN, ANDREW D (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:MANN
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 1:27 PARK ST.
Mailing Address - Street 2:C/O CAPE COD HOSPITAL
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-862-5845
Mailing Address - Fax:508-862-7387
Practice Address - Street 1:27 PARK ST.
Practice Address - Street 2:C/O CAPE COD HOSPITAL
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-5845
Practice Address - Fax:508-862-7387
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010553792084P0800X, 2084P0804X
MA539112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AM055379OtherCHAMPUS-CHAMPUS
AM055379OtherCOMMERCIAL-COMMERCIAL NUMBER
MI258880110Medicaid
700H262290OtherBLUE CROSS-BLUE CROSS
AM055379OtherCOMMERCIAL-COMMERCIAL NUMBER
AM055379OtherCHAMPUS-CHAMPUS