MEDICARE: PATRICIA A DAULEY PA-C

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	363AM0700X	Medical Physician Assistant	1095	MA

General Provider Information

NPI Number	:	1578533501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A DAULEY PA-C

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

Provider Business Practice Location Address
First Line	:	3300 MAIN ST
Second Line	:	3RD FLOOR, SUITE A
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-1002
Country	:	US
Telephone Number	:	413-794-7031
Fax Number	:	413-794-7133

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	08/25/2015

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