Individual
ANDREA RADEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
960 MAIN ST, BRANFORD, CT 06405-3730
(203) 488-6358
(203) 481-5327
Mailing address
960 MAIN ST, BRANFORD, CT 06405-3730
(203) 488-6358
(203) 481-5327
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042296
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001422964
—
CT
01
—
010042296CT01
ANTHEM BCBS
—
01
—
042296
CONNECTICARE
—
01
—
0Q2728
HEALTHNET
—
01
—
3680171
AETNA
—
01
—
P00140199
RAILROAD MEDICARE
—
01
—
P3340613
OXFORD
—
Enumeration date
04/13/2006
Last updated
02/03/2022
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