Provider Demographics
NPI:1124080619
Name:BARATTA, ANDREA (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:BARATTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 BRIGGS RD STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4602
Mailing Address - Country:US
Mailing Address - Phone:609-288-6884
Mailing Address - Fax:609-667-7103
Practice Address - Street 1:2026 BRIGGS RD STE B
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4602
Practice Address - Country:US
Practice Address - Phone:609-288-6884
Practice Address - Fax:609-667-7103
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07528000174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0065293Medicaid
NJ5633C1OtherEMPIRE BC/BS OF NY
NJ7918622OtherAETNA PPO #
NJ2423392000OtherAMERIHEALTH #
NJ1064395OtherAETNA HMO #
NJ223806823OtherTAX IDENTIFICATION #
NJ5633C1OtherEMPIRE BC/BS OF NY
NJ2423392000OtherAMERIHEALTH #