Provider Demographics
NPI:1871159848
Name:MOON, ANDREW S (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:MOON
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 1:7 HAY RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3609
Mailing Address - Country:US
Mailing Address - Phone:978-201-2568
Mailing Address - Fax:
Practice Address - Street 1:54 HOPEDALE ST STE 3
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-1719
Practice Address - Country:US
Practice Address - Phone:617-431-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1022837207XS0117X
CAA195409207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine