Healthcare Provider Details

I. General information

NPI: 1881685485
Provider Name (Legal Business Name): ANDREW JOSEPH PRYHARSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 INDEPENDENCE AVE
QUINCY MA
02169-7751
US

IV. Provider business mailing address

191 INDEPENDENCE AVE
QUINCY MA
02169-7751
US

V. Phone/Fax

Practice location:
  • Phone: 617-773-5070
  • Fax: 617-472-2380
Mailing address:
  • Phone: 617-773-5070
  • Fax: 617-472-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number703858
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: