Provider Demographics
NPI:1053375915
Name:MACKENZIE, ANDREW PAUL (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PAUL
Last Name:MACKENZIE
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 1:346 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1871
Mailing Address - Country:US
Mailing Address - Phone:860-928-0870
Mailing Address - Fax:860-963-3837
Practice Address - Street 1:346 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1871
Practice Address - Country:US
Practice Address - Phone:860-928-0832
Practice Address - Fax:860-963-3837
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217664207V00000X, 207VM0101X
CT47186207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology