Healthcare Provider Details

I. General information

NPI: 1649369133
Provider Name (Legal Business Name): TEDD H ACKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOLYOKE HOSPITAL 575 BEECH STREET
HOLYOKE MA
01040
US

IV. Provider business mailing address

HOLYOKE HOSPITAL 575 BEECH STREET
HOLYOKE MA
01040
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-2697
  • Fax: 413-534-2724
Mailing address:
  • Phone: 413-534-2697
  • Fax: 413-534-2724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number78810
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: