Provider Demographics
NPI:1134626252
Name:PELLETIER, ANDREW (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 NAHANT ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3315
Mailing Address - Country:US
Mailing Address - Phone:815-960-7037
Mailing Address - Fax:
Practice Address - Street 1:98 NAHANT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3315
Practice Address - Country:US
Practice Address - Phone:781-596-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0071501213ES0103X
MA2524213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery