Provider Demographics
NPI:1962575407
Name:WELLS, ANDREW C (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:23 EAST ST
Mailing Address - City:BETHLEHEM
Mailing Address - State:CT
Mailing Address - Zip Code:06751-0490
Mailing Address - Country:US
Mailing Address - Phone:203-266-5226
Mailing Address - Fax:203-266-5226
Practice Address - Street 1:22EAST ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:CT
Practice Address - Zip Code:06751-0490
Practice Address - Country:US
Practice Address - Phone:203-277-5226
Practice Address - Fax:203-266-5236
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT16148207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001161488Medicaid
CTCS9941Medicare UPIN
CTD400015758Medicare PIN
CTC59941Medicare UPIN