Healthcare Provider Details

I. General information

NPI: 1700855053
Provider Name (Legal Business Name): FAIRVIEW PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 MEMORIAL DR
CHICOPEE MA
01020-3958
US

IV. Provider business mailing address

1176 MEMORIAL DR
CHICOPEE MA
01020-3958
US

V. Phone/Fax

Practice location:
  • Phone: 413-593-1333
  • Fax: 413-593-1444
Mailing address:
  • Phone: 413-593-1333
  • Fax: 413-593-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number205617
License Number StateMA

VIII. Authorized Official

Name: DR. JAMES A BELL
Title or Position: PHYSICIAN
Credential: MD
Phone: 413-593-1333