Healthcare Provider Details

I. General information

NPI: 1528588589
Provider Name (Legal Business Name): JOHN ANDREA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TSIENNETO RD STE 300
DERRY NH
03038-1584
US

IV. Provider business mailing address

6 TSIENNETO RD STE 300
DERRY NH
03038-1584
US

V. Phone/Fax

Practice location:
  • Phone: 603-216-0400
  • Fax: 603-216-3800
Mailing address:
  • Phone: 603-216-0400
  • Fax: 603-216-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38700
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number287425
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number287425
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number38700
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: