Basic Information
| Provider Information | |||||||||
| NPI: | 1891853859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDRADA | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 ALUMNI DR | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038332128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035806793 | ||||||||
| FaxNumber: | 6035807006 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 ALUMNI DR | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038332128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035806793 | ||||||||
| FaxNumber: | 6035807006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 01/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | EC-05-052 | ME | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 13813 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30207908 | 05 | NH | MEDICAID | 433007799 | 05 | ME | MEDICAID | AA121060 | 01 | NH | HARVARD | OTHER | 2155796 | 05 | MA | MEDICAID | 3743753 | 01 | NH | CIGNA | OTHER | 1891853859 | 01 | NH | ANTHEM BC BS | OTHER | P00647521 | 01 | NH | RAILROAD MEDICARE | OTHER |