Basic Information
Provider Information | |||||||||
NPI: | 1851385173 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BAXTER | ||||||||
FirstName: | ANDREW | ||||||||
MiddleName: | R.G. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MILLS-BAXTER | ||||||||
OtherFirstName: | ANDREW | ||||||||
OtherMiddleName: | R.G. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 111 FOUNDERS PLZ | ||||||||
Address2: | #300 C/O IPMS | ||||||||
City: | EAST HARTFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 061083212 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8602824022 | ||||||||
FaxNumber: | 8602820834 | ||||||||
Practice Location | |||||||||
Address1: | 111 FOUNDERS PLZ | ||||||||
Address2: | #300 C/O IPMS | ||||||||
City: | EAST HARTFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 061083212 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8602824022 | ||||||||
FaxNumber: | 8602820834 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/01/2005 | ||||||||
LastUpdateDate: | 04/14/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 038633 | CT | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 001386334 | 05 | CT |   | MEDICAID |