Healthcare Provider Details

I. General information

NPI: 1578500765
Provider Name (Legal Business Name): GAURAV CHAWLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 NORTHAMPTON ST EASTHAMPTON HEALTH CENTER
EASTHAMPTON MA
01027-1046
US

IV. Provider business mailing address

PO BOX 8019
SPRINGFIELD MA
01102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 413-529-9300
  • Fax: 413-282-3880
Mailing address:
  • Phone: 866-431-4077
  • Fax: 413-774-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number216799
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number216799
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: