MEDICARE: ANDREA F DOUGLAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	047780	CT

General Provider Information

NPI Number	:	1184656779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA F DOUGLAS M.D.

Provider Business Mailing Address
First Line	:	25 VALLEY DR
Second Line	:
City	:	GREENWICH
State	:	CT
Zip	:	06831-5203
Country	:	US
Telephone Number	:	203-661-3333
Fax Number	:	203-661-5610

Provider Business Practice Location Address
First Line	:	25 VALLEY DR
Second Line	:
City	:	GREENWICH
State	:	CT
Zip	:	06831-5203
Country	:	US
Telephone Number	:	203-661-3333
Fax Number	:	203-661-5610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	05/10/2017

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