Healthcare Provider Details

I. General information

NPI: 1083646517
Provider Name (Legal Business Name): VAMSEEDHAR ALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 BEECH ST
HOLYOKE MA
01040-2223
US

IV. Provider business mailing address

16 CANOE BIRCH CT
BERLIN CT
06037-4088
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number226230
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: