Healthcare Provider Details

I. General information

NPI: 1104947480
Provider Name (Legal Business Name): ANDREW J. DADAGIAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 FIELD ST
NEW BEDFORD MA
02740-2134
US

IV. Provider business mailing address

225 FIELD ST
NEW BEDFORD MA
02740-2134
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-2500
  • Fax:
Mailing address:
  • Phone: 508-991-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number30374
License Number StateMA

VIII. Authorized Official

Name: DR. ANDREW J DADAGIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 508-991-2500