Healthcare Provider Details

I. General information

NPI: 1962575407
Provider Name (Legal Business Name): ANDREW C. WELLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22EAST ST
BETHLEHEM CT
06751-0490
US

IV. Provider business mailing address

PO BOX 490 23 EAST ST
BETHLEHEM CT
06751-0490
US

V. Phone/Fax

Practice location:
  • Phone: 203-277-5226
  • Fax: 203-266-5236
Mailing address:
  • Phone: 203-266-5226
  • Fax: 203-266-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16148
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: