Healthcare Provider Details

I. General information

NPI: 1710018528
Provider Name (Legal Business Name): HAMPSHIRE PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179A NORTHAMPTON ST.
EASTHAMPTON MA
01027
US

IV. Provider business mailing address

179A NORTHAMPTON ST
EASTHAMPTON MA
01027
US

V. Phone/Fax

Practice location:
  • Phone: 413-529-0600
  • Fax: 413-529-1919
Mailing address:
  • Phone: 413-529-0600
  • Fax: 413-529-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72019
License Number StateMA

VIII. Authorized Official

Name: SUSAN GAIL RAY-LAMOND
Title or Position: PRESIDENT/PEDIATRICIAN
Credential: MD
Phone: 413-529-0600