Healthcare Provider Details

I. General information

NPI: 1205112901
Provider Name (Legal Business Name): RACHELLE ANDRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHELLE DAROUT MD

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 WATERFORD PKWY S
WATERFORD CT
06385-1234
US

IV. Provider business mailing address

196 WATERFORD PKWY S
WATERFORD CT
06385-1234
US

V. Phone/Fax

Practice location:
  • Phone: 860-437-6764
  • Fax: 860-865-2392
Mailing address:
  • Phone: 860-437-6764
  • Fax: 860-865-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number54626
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: