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General NPI Number Information
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NPI Number | 1184917775
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Entity Type | Organization
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Legal Business Name | ANDREA CHISHOLM MD LLC
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 55 HIGHLAND AVE STE 103
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City | SALEM
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State | MA
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Zip | 01970-2100
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Country | US
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Telephone | 978-741-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 28 CANDLEWOOD RD
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City | IPSWICH
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State | MA
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Zip | 01938-2717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | ANDREA CHISHOLM
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Credential | MD
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Telephone | 978-836-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 155750
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License Number State | MA
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