=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528588589
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ANDREA DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2017
-----------------------------------------------------
Last Update Date | 11/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 TSIENNETO RD STE 300
-----------------------------------------------------
City | DERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03038-1584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-216-0400
-----------------------------------------------------
Fax | 603-216-3800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 TSIENNETO RD STE 300
-----------------------------------------------------
City | DERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03038-1584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-216-0400
-----------------------------------------------------
Fax | 603-216-3800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 38700
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 287425
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 287425
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 38700
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------