Healthcare Provider Details

I. General information

NPI: 1255332821
Provider Name (Legal Business Name): ANDREW J ARRISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MAIN ST
WALPOLE MA
02081-1718
US

IV. Provider business mailing address

1350 MAIN ST
WALPOLE MA
02081-1718
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-2200
  • Fax: 508-668-6539
Mailing address:
  • Phone: 508-668-2200
  • Fax: 508-668-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47482
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier23389
Identifier TypeOTHER
Identifier State
Identifier IssuerCMSP/HSP
# 2
Identifier607040
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA/US HEALTH CARE HMO
# 3
IdentifierHPHC
Identifier TypeOTHER
Identifier State
Identifier Issuer20607
# 4
IdentifierP2679269
Identifier TypeOTHER
Identifier State
Identifier IssuerOXFORD
# 5
Identifier047482
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS
# 6
Identifier4019679
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA/US HEALTH CARE
# 7
Identifier7385953
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 8
Identifier0136778
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 9
Identifier47482
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICAL LICENSE
# 10
IdentifierC24031
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS OF MA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: