Provider Demographics
NPI:1386704682
Name:ADADE, ANDREWS ADU (MD , MPH)
Entity type:Individual
Prefix:
First Name:ANDREWS
Middle Name:ADU
Last Name:ADADE
Suffix:
Gender:M
Credentials:MD , MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HILLANDALE AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2808
Mailing Address - Country:US
Mailing Address - Phone:203-327-9333
Mailing Address - Fax:203-325-8566
Practice Address - Street 1:18 HILLANDALE AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2808
Practice Address - Country:US
Practice Address - Phone:203-327-9333
Practice Address - Fax:203-325-8566
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0259192080A0000X
NY1622322080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00894808Medicaid
CT001259191Medicaid
NY00894808Medicaid