Provider Demographics
NPI:1730157868
Name:HANSEN, ANDREW C (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON STREET, GREEN #563
Mailing Address - Street 2:HAND SURGERY PC
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:617-965-4263
Mailing Address - Fax:617-928-0597
Practice Address - Street 1:2000 WASHINGTON STREET, GREEN #563
Practice Address - Street 2:HAND SURGERY PC
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-965-4263
Practice Address - Fax:617-928-0597
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5972709-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ53029Medicare UPIN