Healthcare Provider Details

I. General information

NPI: 1861583171
Provider Name (Legal Business Name): ANDREA MILLIGAN P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST A MAIN, ORTHOPEDICS
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST A MAIN, ORTHOPEDICS
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1783
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: