Provider Demographics
NPI:1073673711
Name:PORITZ, ANDY H (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:H
Last Name:PORITZ
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 1:205 GARDNER ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-739-3647
Mailing Address - Fax:
Practice Address - Street 1:300 GROVE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3908
Practice Address - Country:US
Practice Address - Phone:508-754-0700
Practice Address - Fax:508-831-9989
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58158207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3024181Medicaid
MA3024181Medicaid
MAJ06621Medicare ID - Type Unspecified