Provider Demographics
NPI:1487273710
Name:DESROSIERS, ANDREW STEVENS (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEVENS
Last Name:DESROSIERS
Suffix:
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 1:16 WOODBINE LANE / MAIL CODE: 5206
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-5206
Mailing Address - Country:US
Mailing Address - Phone:570-271-8050
Mailing Address - Fax:570-271-5940
Practice Address - Street 1:16 WOODBINE LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8029
Practice Address - Country:US
Practice Address - Phone:570-271-8050
Practice Address - Fax:570-271-5940
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program