Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MB10574200 | NJ |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 289253 | MA |
NPI | 1124454822 |
---|---|
Provider Name | Dr. Andrew James Mostello |
First Address | Leominster, MA 01453-2253 |
Second Address | Leominster, MA 01453-2253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2013 |
Last Update Date | 01/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124454822 | (05) | VA |