Provider Demographics
NPI:1831304237
Name:ANDOVER OBSTETRICS AND GYNECOLOGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:ANDOVER OBSTETRICS AND GYNECOLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RADKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-475-2731
Mailing Address - Street 1:323 LOWELL STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4501
Mailing Address - Country:US
Mailing Address - Phone:978-475-2731
Mailing Address - Fax:978-975-2536
Practice Address - Street 1:323 LOWELL STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4501
Practice Address - Country:US
Practice Address - Phone:978-475-2731
Practice Address - Fax:978-975-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty