Provider Demographics
NPI:1174780837
Name:BRIDGE, ANDREW T (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:T
Last Name:BRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13000 N MERIDIAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1404
Mailing Address - Country:US
Mailing Address - Phone:317-208-3813
Mailing Address - Fax:317-208-3815
Practice Address - Street 1:13000 N MERIDIAN ST STE 101
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1404
Practice Address - Country:US
Practice Address - Phone:317-208-3813
Practice Address - Fax:317-208-3815
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065291A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000698538OtherANTHEM PROVIDER NUMBER
IN201009500Medicaid
IN000000698538OtherANTHEM PROVIDER NUMBER
INP00911286Medicare PIN