Healthcare Provider Details

I. General information

NPI: 1659722312
Provider Name (Legal Business Name): DAVID MA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 LOWELL ST STE 302
ANDOVER MA
01810-4659
US

IV. Provider business mailing address

1 GENERAL STREET PROVIDER ENROLLMENT
LAWRENCE MA
01842
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-4202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number277283
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number277283
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: