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NPI Code Detail

MEDICARE: MR. JASON D. ANDRUS PA-C

MEDICARE: MR. JASON D. ANDRUS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant1011CT

General Provider Information

NPI Number : 1104808369
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON D. ANDRUS PA-C
Provider Business Mailing Address
First Line : 435 LEWIS AVE
Second Line :
City : MERIDEN
State : CT
Zip : 06451-2101
Country : US
Telephone Number : 833-203-7523
Fax Number :
Provider Business Practice Location Address
First Line : 435 LEWIS AVE
Second Line :
City : MERIDEN
State : CT
Zip : 06451-2101
Country : US
Telephone Number : 833-203-7523
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 08/07/2025

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