Healthcare Provider Details

I. General information

NPI: 1750596201
Provider Name (Legal Business Name): NORTHERN BERKSHIRE PEDIATRICS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HOSPITAL AVE. SUITE 302
NORTH ADAMS MA
01247-2538
US

IV. Provider business mailing address

77 HOSPITAL AVE., SUITE 302 AMBULATORY CARE CENTER
NORTH ADAMS MA
01247-2538
US

V. Phone/Fax

Practice location:
  • Phone: 413-663-8365
  • Fax: 413-662-2363
Mailing address:
  • Phone: 413-663-8365
  • Fax: 413-662-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: SUSAN KING
Title or Position: PRACTICE MANAGER
Credential:
Phone: 413-663-8365