Provider Demographics
NPI:1609913706
Name:TOWN OF ANDOVER
Entity type:Organization
Organization Name:TOWN OF ANDOVER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-623-8295
Mailing Address - Street 1:36 BARTLET ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-623-8295
Mailing Address - Fax:978-623-8320
Practice Address - Street 1:36 BARTLET ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3813
Practice Address - Country:US
Practice Address - Phone:978-623-8295
Practice Address - Fax:978-623-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11018Medicare ID - Type Unspecified