Healthcare Provider Details

I. General information

NPI: 1568994739
Provider Name (Legal Business Name): JASON MICHAEL ANDREAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HOWARD AVENUE
CRANSTON RI
02920
US

IV. Provider business mailing address

11 HOWARD AVENUE
CRANSTON RI
02920
US

V. Phone/Fax

Practice location:
  • Phone: 401-462-2013
  • Fax:
Mailing address:
  • Phone: 401-462-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberDO01081
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO01081
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: