NPIMap

Organization Active NPI

Andover Dermatology, PC

  • Dermatology Physician
  • Andover, MA
National Provider Identifier
1629293485
Registry record updated Jul 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ANDOVER DERMATOLOGY, PC
Practice address
138 Haverhill St
Suite 200
Andover, MA 01810
Phone
(978) 475-4322
Fax
(978) 474-4537
NPI assigned
Apr 16, 2007
Last updated
Jul 9, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Christine H Andersen, MDNPI 1093734691
Title
President
Phone
(978) 475-4322

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

138 Haverhill St
Suite 200
Andover, MA 01810

Mailing address

138 Haverhill St
Suite 200
Andover, MA 01810-1509
Phone (978) 475-4322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031208000588 MA Part B Supplier - Clinic/Group Practice 2860398336 Receives reassigned benefits from 2 practitioners
Practice locations: Andover, MA
O20140820000702 NH Part B Supplier - Clinic/Group Practice 2860398336 Receives reassigned benefits from 3 practitioners
Practice locations: Salem, NH

National Provider Directory

National Provider Directory

Locations

138 Haverhill St
Ste 200
Andover, MA 01810
Phone (978) 470-2314

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531094400000",
    "number": "1629293485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 HAVERHILL ST",
            "address_2": "SUITE 200",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018101509",
            "telephone_number": "978-475-4322",
            "fax_number": "978-474-4537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 HAVERHILL ST",
            "address_2": "SUITE 200",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "01810",
            "telephone_number": "978-475-4322",
            "fax_number": "978-474-4537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDOVER DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2018-07-09",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-475-4322",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.