Healthcare Provider Details

I. General information

NPI: 1295884500
Provider Name (Legal Business Name): PIONEER VALLEY ENT SURGEONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 STRAW AVE
FLORENCE MA
01062-1464
US

IV. Provider business mailing address

15 STRAW AVE
FLORENCE MA
01062-1464
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-7100
  • Fax:
Mailing address:
  • Phone: 413-586-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL STAMM
Title or Position: OWNER
Credential: M.D.
Phone: 413-586-7100