Basic Information
| Provider Information | |||||||||
| NPI: | 1649279167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORMSER | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 WASHINGTON AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032483013 | ||||||||
| FaxNumber: | 2032482878 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 PRINCE ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037720011 | ||||||||
| FaxNumber: | 2037859352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 10/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 1266238 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0Q2059 | 01 | CT | HEALTH NET | OTHER | 110158519 | 01 | CT | RAILROAD MEDICARE | OTHER | 2047739 | 01 | CT | AETNA | OTHER | 726623 | 01 | CT | CONNECTICARE | OTHER | NHP073 | 01 | CT | OXFORD | OTHER | 010026623CT01 | 01 | CT | BLUE CROSS BLUE SHIELD | OTHER |