Healthcare Provider Details

I. General information

NPI: 1649645201
Provider Name (Legal Business Name): ANDREW R PHENIX PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS STREET, PBB-B 428 BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115
US

IV. Provider business mailing address

237 STATE RD
DARTMOUTH MA
02747-2612
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone: 508-979-5557
  • Fax: 508-979-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA5570
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: