Provider Demographics
NPI:1275685117
Name:GOTTLIEB, ANDREW (NP)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 REGIS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3517
Mailing Address - Country:US
Mailing Address - Phone:617-724-3905
Mailing Address - Fax:617-724-3944
Practice Address - Street 1:165 CHARLES RIVER PLAZA
Practice Address - Street 2:SUITE 404
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2750
Practice Address - Country:US
Practice Address - Phone:617-724-3905
Practice Address - Fax:617-724-3944
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243813363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health