Healthcare Provider Details

I. General information

NPI: 1467424150
Provider Name (Legal Business Name): ROBERT R AJELLO MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 HIGH ST STE 200
GREENFIELD MA
01301
US

IV. Provider business mailing address

PO BOX 920
WILBRAHAM MA
01095-0920
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-2840
  • Fax: 413-773-2841
Mailing address:
  • Phone: 508-595-0531
  • Fax: 508-829-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number76900
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number76900
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number76900
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number76900
License Number StateMA

VIII. Authorized Official

Name: DR. ROBERT R AJELLO
Title or Position: MD SOLE PROPRIETOR
Credential: MD
Phone: 413-773-2840