Healthcare Provider Details

I. General information

NPI: 1295814812
Provider Name (Legal Business Name): TRUSTEES OF PHILLIPS ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MAIN ST
ANDOVER MA
01810-4166
US

IV. Provider business mailing address

180 MAIN ST
ANDOVER MA
01810-4166
US

V. Phone/Fax

Practice location:
  • Phone: 978-749-4455
  • Fax: 978-749-4452
Mailing address:
  • Phone: 978-749-4455
  • Fax: 978-749-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License NumberEXEMPT
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2165
License Number StateMA

VIII. Authorized Official

Name: DR. AMY PATEL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 978-749-4461