Individual
C WALLACE ANDRIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
235 LESTERTOWN RD, GROTON, CT 06340-2808
(860) 822-3547
Mailing address
88 PAYER LN, MYSTIC, CT 06355
(860) 822-3547
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
20133
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001201334
BLUECARE FAMILY PLAN
—
05
—
001201334
—
CT
01
—
010020133CT02
ANTHEM/ECCG:06-1049086
—
01
—
010020133CT06
ANTHEM/ECCD:06-1616101
—
01
—
020133
CONNECTICARE
—
01
—
030265
HEALTHNET/ECCG:06-1049086
—
01
—
060014262
RR MED/ECCG: 06-1049086
—
01
—
060064826
RR MED/ECCD: 06-1616101
—
01
—
0V9740
HEALTHNET/ECCD:06-1616101
—
01
—
500HBC444CT01
ANTHEM/HOSP-BASED ECCD
—
01
—
NLS101
OXFORD/ECCG: 06-1049086
—
01
—
P2524339
OXFORD/ECCD: 06-1616101
—
Enumeration date
05/18/2006
Last updated
07/21/2022
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