Provider Demographics
NPI:1205367331
Name:WILKS, ANDREW BRADFORD (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRADFORD
Last Name:WILKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 HARRISON AVENUE, 3RD FL
Practice Address - Street 2:MOAKLEY BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-638-6428
Practice Address - Fax:617-638-5756
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2023-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1015963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine