Healthcare Provider Details

I. General information

NPI: 1063484038
Provider Name (Legal Business Name): PATRICIA A IVERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 CONWAY ST VALLEY MEDICAL GROUP, PC-GREENFIELD HEALTH CENTER
GREENFIELD MA
01301
US

IV. Provider business mailing address

329 CONWAY ST VALLEY MEDICAL GROUP, PC-GREENFIELD HEALTH CENTER
GREENFIELD MA
01301
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-6301
  • Fax: 866-644-0871
Mailing address:
  • Phone: 413-774-6301
  • Fax: 866-644-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60263
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: