Healthcare Provider Details

I. General information

NPI: 1396752051
Provider Name (Legal Business Name): MARY M BARTLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SARGENT ST
BELCHERTOWN MA
01007-9881
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-323-7212
  • Fax: 413-967-2524
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number213407
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: