Basic Information
| Provider Information | |||||||||
| NPI: | 1831262575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUKIENNIK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | WALTER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 WHITTEMORE TERRACE | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018101442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788865359 | ||||||||
| FaxNumber: | 7819351391 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817293858 | ||||||||
| FaxNumber: | 7817567135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 11/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 76384 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 76384 | MA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3095525 | 05 | MA | MEDICAID |