Basic Information
| Provider Information | |||||||||
| NPI: | 1437562584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AXTELL | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | MASSACHUSETTS GENERAL HOSPITAL | ||||||||
| Address2: | 55 FRUIT STREET | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177262800 | ||||||||
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| Practice Location | |||||||||
| Address1: | MASSACHUSETTS GENERAL HOSPITAL | ||||||||
| Address2: | 55 FRUIT STREET | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177262800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2014 | ||||||||
| LastUpdateDate: | 06/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | L-259165 | MA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.