MEDICARE: ANDREW K FAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	152482	MA

General Provider Information

NPI Number	:	1508872359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW K FAY MD

Provider Business Mailing Address
First Line	:	280 CHESTNUT ST
Second Line	:	2ND FLOOR
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-1001
Country	:	US
Telephone Number	:	413-794-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 GRANBY RD
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-3218
Country	:	US
Telephone Number	:	413-533-3926
Fax Number	:	413-794-8732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/15/2016

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