Provider Demographics
NPI:1407062680
Name:ANDREA J. FRIBUSH, MD LLC
Entity Type:Organization
Organization Name:ANDREA J. FRIBUSH, MD LLC
Other - Org Name:ANDREA J. FRIBUSH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-371-7176
Mailing Address - Street 1:131 OLD ROAD TO 9 ACRE COR
Mailing Address - Street 2:SUITE 570
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4181
Mailing Address - Country:US
Mailing Address - Phone:978-371-7176
Mailing Address - Fax:978-371-7136
Practice Address - Street 1:131 OLD ROAD TO 9 ACRE COR
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:978-371-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0031521OtherNEIGHBORHOOD HEALTH CARE
MAM18334OtherBLUE CROSS/BLUE SHIELD
MA59676OtherFALLON