Healthcare Provider Details

I. General information

NPI: 1013605096
Provider Name (Legal Business Name): MUHAMMAD EHTESHAM JAVED M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date: 11/29/2023
Reactivation Date: 05/23/2024

III. Provider practice location address

164 HIGH ST FL 1
GREENFIELD MA
01301-2613
US

IV. Provider business mailing address

280 CHESTNUT ST
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-4320
  • Fax: 413-794-1767
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1026691
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1026691
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: