Healthcare Provider Details

I. General information

NPI: 1639170848
Provider Name (Legal Business Name): ANDREW K PALMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HARRY KEMP WAY
PROVINCETOWN MA
02657-1618
US

IV. Provider business mailing address

5 TEAL WAY
EASTHAM MA
02642-3411
US

V. Phone/Fax

Practice location:
  • Phone: 508-487-9395
  • Fax: 508-487-3285
Mailing address:
  • Phone: 774-207-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number129906
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number129906
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number244733
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: