Provider Demographics
NPI:1619933090
Name:BARRETT, ANDREA L (PA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:BLAKE BLDG 1570
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-2330
Mailing Address - Fax:617-726-7667
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BLAKE BLDG 1570
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2330
Practice Address - Fax:617-726-7667
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00755363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS74610Medicare UPIN
MAAP1633Medicare ID - Type Unspecified