NPIMap

Organization Active NPI

Andover Obstetrics and Gynecological Associates, PC

  • Specialist
  • Andover, MA
National Provider Identifier
1831304237
Registry record updated May 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
81954 Issued in MA
Legal business name
ANDOVER OBSTETRICS AND GYNECOLOGICAL ASSOCIATES, PC
Practice address
323 Lowell Street
Suite 302
Andover, MA 01810-4501
Phone
(978) 475-2731
Fax
(978) 975-2536
NPI assigned
May 11, 2007
Last updated
May 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2016

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

Authorized official

Name
Mr. Edwin C Radke, MDNPI 1184661761
Title
President
Phone
(978) 475-2731

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
Specialist 174400000X 81954 MA Primary

Addresses

Primary practice location

323 Lowell Street
Suite 302
Andover, MA 01810-4501

Mailing address

323 Lowell Street
Suite 302
Andover, MA 01810-4501
Phone (978) 475-2731

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040615000829 MA Part B Supplier - Clinic/Group Practice 0345224648 Receives reassigned benefits from 20 practitioners
Practice locations: Haverhill, MA; Lawrence, MA; Andover, MA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D0071283Andover Obstetrics & Gynecological Associates PC323 Lowell St Ste 302, Andover, MA 01810ComplianceSep 21, 2026

National Provider Directory

National Provider Directory

Locations

1 General St
Bsmt
Lawrence, MA 01841
Phone (978) 685-1594

29 Stiles Rd
Ste 204
Salem, NH 03079

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463616000000",
    "number": "1831304237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 LOWELL STREET",
            "address_2": "SUITE 302",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018104501",
            "telephone_number": "978-475-2731",
            "fax_number": "978-975-2536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 LOWELL STREET",
            "address_2": "SUITE 302",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018104501",
            "telephone_number": "978-475-2731",
            "fax_number": "978-975-2536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDOVER OBSTETRICS AND GYNECOLOGICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2016-05-19",
        "status": "A",
        "authorized_official_last_name": "RADKE",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-475-2731",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MA",
            "license": "81954",
            "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 May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.