Healthcare Provider Details

I. General information

NPI: 1821750688
Provider Name (Legal Business Name): ANDREW DEONARINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 ARNOLD CRESCENT
ANGUS ONTARIO
L0M1B6
CA

IV. Provider business mailing address

146 ARNOLD CRESCENT
ANGUS ONTARIO
L0M1B6
CA

V. Phone/Fax

Practice location:
  • Phone: 617-401-8246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number57125
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number57125
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: