Healthcare Provider Details

I. General information

NPI: 1912965468
Provider Name (Legal Business Name): IRENE N CODY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAIN ST
AGAWAM MA
01001-1838
US

IV. Provider business mailing address

230 MAIN ST
AGAWAM MA
01001-1838
US

V. Phone/Fax

Practice location:
  • Phone: 413-789-6800
  • Fax: 413-789-5171
Mailing address:
  • Phone: 413-789-6800
  • Fax: 413-789-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number227389
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: