Healthcare Provider Details

I. General information

NPI: 1457567471
Provider Name (Legal Business Name): ANDREW RICHARDSON SCOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHARLES ST
BOSTON MA
02114-3096
US

IV. Provider business mailing address

243 CHARLES ST
BOSTON MA
02114-3096
US

V. Phone/Fax

Practice location:
  • Phone: 617-573-3190
  • Fax:
Mailing address:
  • Phone: 617-573-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number245003
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number245003
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: