Provider Demographics
NPI:1255332821
Name:ARRISON, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:ARRISON
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 1:1350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1718
Mailing Address - Country:US
Mailing Address - Phone:508-668-2200
Mailing Address - Fax:508-668-6539
Practice Address - Street 1:1350 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1718
Practice Address - Country:US
Practice Address - Phone:508-668-2200
Practice Address - Fax:508-668-6539
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47482208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
23389OtherCMSP/HSP
607040OtherAETNA/US HEALTH CARE HMO
HPHCOther20607
P2679269OtherOXFORD
047482OtherTUFTS
4019679OtherAETNA/US HEALTH CARE
7385953OtherCIGNA
MA0136778Medicaid
47482OtherMEDICAL LICENSE
C24031OtherBCBS OF MA
C24031OtherBCBS OF MA