Healthcare Provider Details

I. General information

NPI: 1316414162
Provider Name (Legal Business Name): ANDREW JAMES ROBITAILLE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON ST
BOXFORD MA
01921-1017
US

IV. Provider business mailing address

35 UNITED DR STE 102
WEST BRIDGEWATER MA
02379-1056
US

V. Phone/Fax

Practice location:
  • Phone: 978-296-3781
  • Fax: 978-296-3783
Mailing address:
  • Phone: 508-238-8646
  • Fax: 508-230-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1445
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA7924
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: