Healthcare Provider Details

I. General information

NPI: 1982642559
Provider Name (Legal Business Name): ANDREA STRACCIOLINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 LONGWOOD AVE
BOSTON MA
02115-5728
US

IV. Provider business mailing address

319 LONGWOOD AVE
BOSTON MA
02115-5728
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6028
  • Fax: 617-731-5298
Mailing address:
  • Phone: 617-355-6028
  • Fax: 617-731-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number153377
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number153377
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number153377
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: