Individual
SAMUEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(978) 766-2413
Mailing address
PROVIDER ENROLLMENT 41 MALL ROAD, BURLINGTON, MA 01805-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA8577
MA
363A00000X
Physician Assistant
—
—
Other
Enumeration date
01/27/2022
Last updated
09/03/2024
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