Healthcare Provider Details

I. General information

NPI: 1831304237
Provider Name (Legal Business Name): ANDOVER OBSTETRICS AND GYNECOLOGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 LOWELL STREET SUITE 302
ANDOVER MA
01810-4501
US

IV. Provider business mailing address

323 LOWELL STREET SUITE 302
ANDOVER MA
01810-4501
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-2731
  • Fax: 978-975-2536
Mailing address:
  • Phone: 978-475-2731
  • Fax: 978-975-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number81954
License Number StateMA

VIII. Authorized Official

Name: MR. EDWIN C RADKE
Title or Position: PRESIDENT
Credential: MD
Phone: 978-475-2731