Healthcare Provider Details

I. General information

NPI: 1649279167
Provider Name (Legal Business Name): ANDREW WORMSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 PRINCE ST
NEW HAVEN CT
06519-1600
US

IV. Provider business mailing address

9 WASHINGTON AVE 2ND FLOOR
HAMDEN CT
06518-3267
US

V. Phone/Fax

Practice location:
  • Phone: 203-772-0011
  • Fax: 203-785-9352
Mailing address:
  • Phone: 203-248-3013
  • Fax: 203-248-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1266238
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: