Provider Demographics
NPI:1548393176
Name:ANDOVER PEDIATRICS
Entity Type:Organization
Organization Name:ANDOVER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MHA
Authorized Official - Phone:978-475-4522
Mailing Address - Street 1:203 TURNPIKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-475-4522
Mailing Address - Fax:978-688-6047
Practice Address - Street 1:203 TURNPIKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-475-4522
Practice Address - Fax:978-688-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM13133OtherBC BS ID NUMBER
MA9716742Medicaid
MA110068132AMedicaid