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General NPI Number Information
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NPI Number | 1578067021
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Entity Type | Individual
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Provider Name | ANDREW JAMES WALL MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 27 PARK ST
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City | HYANNIS
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State | MA
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Zip | 02601-5203
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Country | US
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Telephone | 508-771-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 122 OAKMONT RD
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City | YARMOUTH PORT
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State | MA
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Zip | 02675-1666
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Country | US
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Telephone | 508-314-6235
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 1015660
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License Number State | MA
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