Healthcare Provider Details

I. General information

NPI: 1003930728
Provider Name (Legal Business Name): ALLCROFT FACIAL PLASTIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 CONZ ST
NORTHAMPTON MA
01060-3848
US

IV. Provider business mailing address

163 CONZ ST
NORTHAMPTON MA
01060-3848
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-3200
  • Fax: 413-587-0970
Mailing address:
  • Phone: 413-586-3200
  • Fax: 413-587-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDI C CHAGNON
Title or Position: CREDENTIALS SPECIALIST
Credential:
Phone: 413-582-2656