Healthcare Provider Details

I. General information

NPI: 1982636403
Provider Name (Legal Business Name): ANDREW C BOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

QUINCY MEDICAL CENTER 114 WHITWELL STREET
QUINCY MA
02169
US

IV. Provider business mailing address

24 SOMERSET RD
BROOKLINE MA
02445-6106
US

V. Phone/Fax

Practice location:
  • Phone: 617-376-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70793
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number70793
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number70793
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: