Provider Demographics
NPI:1609879543
Name:ANDREOLI, JOHN W JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:ANDREOLI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-224-6202
Mailing Address - Fax:860-826-4957
Practice Address - Street 1:300 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3916
Practice Address - Country:US
Practice Address - Phone:860-224-6202
Practice Address - Fax:860-826-4957
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010022366CT03OtherBCBS & BCFP PROVIDER ID
CT001223668Medicaid
CT060073OtherHEALTH NET
CT2236601OtherCONNECTICARE
CT60916784OtherAETNA
CTC01373OtherGHMC GROUP MEDICARE ID
CT368660OtherWELLCARE MEDICARE
CTP369891OtherOXFORD
CT004196095OtherGHMC GROUP MEDICAID ID
CT01022366OtherCIGNA
CTD02543Medicare UPIN
CT160000555Medicare ID - Type Unspecified