Provider Demographics
NPI:1548442973
Name:EGAN, ANDREW (OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:EGAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SANBORNVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03872-4365
Mailing Address - Country:US
Mailing Address - Phone:603-522-9226
Mailing Address - Fax:
Practice Address - Street 1:73 HIGH ST
Practice Address - Street 2:
Practice Address - City:SANBORNVILLE
Practice Address - State:NH
Practice Address - Zip Code:03872-4365
Practice Address - Country:US
Practice Address - Phone:603-522-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1357174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30416002Medicaid