Healthcare Provider Details

I. General information

NPI: 1720026685
Provider Name (Legal Business Name): JILL M BASCOMB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 HIGH ST
GREENFIELD MA
01301-2613
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1619
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-2263
  • Fax: 413-773-2127
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number227655
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: