MEDICARE: ANDREW D. MANN 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	2084P0800X	Psychiatry Physician	4301055379	MI
2	2084P0804X	Child & Adolescent Psychiatry Physician	4301055379	MI
3	2084P0800X	Psychiatry Physician	53911	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	AM055379	OTHER	CHAMPUS-CHAMPUS
2	AM055379	OTHER	COMMERCIAL-COMMERCIAL NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	700H262290	OTHER	BLUE CROSS-BLUE CROSS

General Provider Information

NPI Number	:	1740266436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW D. MANN M.D.

Provider Business Mailing Address
First Line	:	27 PARK ST.
Second Line	:	C/O CAPE COD HOSPITAL
City	:	HYANNIS
State	:	MA
Zip	:	02601
Country	:	US
Telephone Number	:	508-862-5845
Fax Number	:	508-862-7387

Provider Business Practice Location Address
First Line	:	27 PARK ST.
Second Line	:	C/O CAPE COD HOSPITAL
City	:	HYANNIS
State	:	MA
Zip	:	02601
Country	:	US
Telephone Number	:	508-862-5845
Fax Number	:	508-862-7387

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/14/2011

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Directions to “ ANDREW D. MANN M.D.” Practice Location

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