Provider Demographics
NPI:1336107309
Name:FRIBUSH, ANDREA (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:FRIBUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 EAST ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1944
Mailing Address - Country:US
Mailing Address - Phone:978-371-7176
Mailing Address - Fax:
Practice Address - Street 1:131 ORNAC
Practice Address - Street 2:SUITE 570
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4181
Practice Address - Country:US
Practice Address - Phone:978-371-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74708207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2904530OtherUNITED HEALTHCARE
MA403OtherFALLON
MAJ14841OtherBLUE CROSS/BLUE SHIELD
MA0031521OtherNEIGHBORHOOD HEALTH
MA119741OtherHEALTHPARTNERS PROVIDER
MA30301OtherHARVARD PILGRIM
MA759759OtherTUFTS
MA2297972OtherCIGNA
MA3135314Medicaid
MA759759OtherTUFTS
MAJ14841Medicare PIN