Provider Demographics
NPI:1962598003
Name:VASCAN, ANDREEA C (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREEA
Middle Name:C
Last Name:VASCAN
Suffix:
Gender:F
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 SOUTH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6440
Practice Address - Country:US
Practice Address - Phone:973-971-7165
Practice Address - Fax:973-290-7576
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME149727207R00000X
ME016260207R00000X
NJ25MA08348100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME286080099Medicaid
ME0498Medicare ID - Type Unspecified
ME286080099Medicaid