Provider Demographics
NPI:1730291402
Name:AHN, ANDREW C (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:AHN
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 1:47 BARBARA RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-4401
Mailing Address - Country:US
Mailing Address - Phone:617-384-8581
Mailing Address - Fax:
Practice Address - Street 1:401 PARK DR
Practice Address - Street 2:SUITE 22A WEST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3325
Practice Address - Country:US
Practice Address - Phone:617-384-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine