Healthcare Provider Details

I. General information

NPI: 1275162463
Provider Name (Legal Business Name): ANDREW JOHN KEHRER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

IV. Provider business mailing address

99 E RIVER DR FL 5
EAST HARTFORD CT
06108-7301
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-6000
  • Fax:
Mailing address:
  • Phone: 860-282-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number78942
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: