Healthcare Provider Details

I. General information

NPI: 1013367515
Provider Name (Legal Business Name): ANDREW THOMAS THORP JR. MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STRAITS TPKE STE 209
MIDDLEBURY CT
06762-1836
US

IV. Provider business mailing address

1625 STRAITS TPKE STE 209
MIDDLEBURY CT
06762-1836
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-9100
  • Fax: 203-758-9400
Mailing address:
  • Phone: 203-758-9100
  • Fax: 203-758-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number61649
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number61649
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: