Healthcare Provider Details

I. General information

NPI: 1053433045
Provider Name (Legal Business Name): ADARSH VASANTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 MASSACHUSETTS AVE
NORTH ANDOVER MA
01845-4143
US

IV. Provider business mailing address

1511 GREAT POND RD
NORTH ANDOVER MA
01845-1216
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-7550
  • Fax: 978-686-5565
Mailing address:
  • Phone: 978-685-7550
  • Fax: 978-686-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number217942
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: