Healthcare Provider Details

I. General information

NPI: 1730179623
Provider Name (Legal Business Name): ANDREW DAVID SIMKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

IV. Provider business mailing address

133 SALEM ST
ANDOVER MA
01810-2210
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-4151
  • Fax: 978-256-3987
Mailing address:
  • Phone: 978-470-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number39025
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: