Provider Demographics
NPI:1336113661
Name:NIERENBERG, ANDREW ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALAN
Last Name:NIERENBERG
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:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0837
Mailing Address - Fax:617-726-6768
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 580
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-724-0837
Practice Address - Fax:617-726-6768
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA560662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA714401OtherTUFTS HEALTH PLAN
MAJ05521OtherBCBS MA
MAJ05521OtherBCBS MA
A58424Medicare UPIN