Provider Demographics
NPI:1477609295
Name:URBAN, ANDREA BETTACCHI (MD)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:BETTACCHI
Last Name:URBAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:BETTACHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 JEFFREY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746
Mailing Address - Country:US
Mailing Address - Phone:508-429-2800
Mailing Address - Fax:508-429-7913
Practice Address - Street 1:100 JEFFREY AVENUE
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746
Practice Address - Country:US
Practice Address - Phone:508-429-2800
Practice Address - Fax:508-429-7913
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228340208000000X
MA239158208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics