Healthcare Provider Details

I. General information

NPI: 1306837174
Provider Name (Legal Business Name): SUSAN ANTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 BEECH ST
HOLYOKE MA
01040-2223
US

IV. Provider business mailing address

20 DANFORTH FARMS RD
WILBRAHAM MA
01095-1797
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-2500
  • Fax:
Mailing address:
  • Phone: 413-596-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number160978
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: