Healthcare Provider Details

I. General information

NPI: 1932584653
Provider Name (Legal Business Name): ANDRUMEDIA ARTI FIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ALBANY TPKE STE 209
CANTON CT
06019-2549
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 300
DOWNERS GROVE IL
60515-1069
US

V. Phone/Fax

Practice location:
  • Phone: 860-693-4060
  • Fax: 860-693-6435
Mailing address:
  • Phone: 630-725-2730
  • Fax: 844-205-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003386
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: