Provider Demographics
NPI:1952586034
Name:ANDREJA PACKARD, MD, PC
Entity Type:Organization
Organization Name:ANDREJA PACKARD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREJA
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:978-537-0493
Mailing Address - Street 1:80 ERDMAN WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1840
Mailing Address - Country:US
Mailing Address - Phone:978-537-0493
Mailing Address - Fax:978-537-0649
Practice Address - Street 1:80 ERDMAN WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1840
Practice Address - Country:US
Practice Address - Phone:978-537-0493
Practice Address - Fax:978-537-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2090202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA38049Medicare PIN