Provider Information for 1396935136
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BIREE ANDEMARIAM MD
Sex: Female
NPI: 1396935136
Last Updated: 2022-09-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1396935136 | ||||||||||||||
| Enumeration Date | 2007-07-27 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 263 FARMINGTON AVE PROVIDER ENROLLMENT - ELLIE ATKINS FARMINGTON, CT 06030-2212 United States Phone: 860-679-7503 | Fax:860-679-1610 | ||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-0001 United States Phone: 860-679-2100 | Fax:860-679-4815 | ||||||||||||||
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