Healthcare Provider Details

I. General information

NPI: 1689500530
Provider Name (Legal Business Name): BRIDGE DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FEDERAL ST
GREENFIELD MA
01301-2546
US

IV. Provider business mailing address

55 FEDERAL ST
GREENFIELD MA
01301-2546
US

V. Phone/Fax

Practice location:
  • Phone: 413-417-8133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GILBERT
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 413-416-1250