Healthcare Provider Details

I. General information

NPI: 1467195420
Provider Name (Legal Business Name): MR. JOSHUA DAVID ROBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
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: 413-786-0913
Mailing address:
  • Phone: 413-789-6800
  • Fax: 413-786-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA8949
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: