Healthcare Provider Details

I. General information

NPI: 1376526509
Provider Name (Legal Business Name): WARREN A ANDIMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST YALE-NEW HAVEN CHILDREN'S HOSPITAL - WEST PAVILION 2ND
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

300 GEORGE ST 6TH FLOOR
NEW HAVEN CT
06511-6624
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4081
  • Fax: 203-785-3833
Mailing address:
  • Phone: 203-785-6610
  • Fax: 203-785-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number016326
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: