Provider Demographics
NPI:1831172162
Name:LIM, ANDREW S (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:63 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-409-1137
Mailing Address - Fax:978-409-1906
Practice Address - Street 1:60 EAST STREET
Practice Address - Street 2:STE #1400
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-689-0869
Practice Address - Fax:978-689-3096
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2022-03-25
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Provider Licenses
StateLicense IDTaxonomies
MA56104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3010805Medicaid
MA56104OtherMASSACHUSETTS LICENSE
MAJ05574OtherBLUE CROSS/ BLUE SHIELD
MAJ05574OtherBLUE CROSS/ BLUE SHIELD