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General NPI Number Information
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NPI Number | 1649518317
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Entity Type | Individual
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Provider Name | ANDREW VASCONCELLOS MD
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Gender | Male
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2200 STATE ST
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City | LAWRENCEVILLE
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State | IL
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Zip | 62439-1899
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Country | US
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Telephone | 618-943-1000
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Fax | 618-943-7242
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Provider Business Mailing Address
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Address Line | 900 NW 13TH ST STE 108
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City | BOCA RATON
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State | FL
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Zip | 33486-2350
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Country | US
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Telephone | 561-672-0907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 036173820
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | LT4364
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | ME137751
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License Number State | FL
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