Provider Demographics
NPI:1215164744
Name:ANDRIOTAKIS, JAMES (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ANDRIOTAKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-0293
Mailing Address - Country:US
Mailing Address - Phone:978-835-3110
Mailing Address - Fax:978-887-5606
Practice Address - Street 1:105 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6825
Practice Address - Country:US
Practice Address - Phone:603-501-5547
Practice Address - Fax:603-501-5650
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16148208100000X
MA252253208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3097731Medicaid