Provider Demographics
NPI:1669639258
Name:ENZINGER, ANDREA CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CATHERINE
Last Name:ENZINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:DANA-FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-3779
Mailing Address - Fax:617-632-5822
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:DANA-FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-3779
Practice Address - Fax:617-632-5822
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA240022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA240022OtherMASSACHUSETTS FULL LICENSE