Healthcare Provider Details

I. General information

NPI: 1023027810
Provider Name (Legal Business Name): MACONY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAPLE AVE STE 1
GREAT BARRINGTON MA
01230-1965
US

IV. Provider business mailing address

100 MAPLE AVE STE 1
GREAT BARRINGTON MA
01230-1965
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-4047
  • Fax: 413-528-3407
Mailing address:
  • Phone: 413-528-4047
  • Fax: 413-528-3407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LAURIE W VIEBROCK
Title or Position: OFFICE MANAGER
Credential:
Phone: 413-528-4047