Provider Demographics
NPI:1962415331
Name:PREZIOSI, ANDREW/ JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW/
Middle Name:JOHN
Last Name:PREZIOSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1702
Mailing Address - Country:US
Mailing Address - Phone:781-662-0081
Mailing Address - Fax:781-662-0279
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 303
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-662-0081
Practice Address - Fax:781-662-0279
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6189741Medicaid
MAJ04101Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
MAD75149Medicare UPIN