Healthcare Provider Details

I. General information

NPI: 1376741249
Provider Name (Legal Business Name): AMANDA RACHEL DICKERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RACHEL WEBB MD

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 12/01/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 LOCUST ST
NORTHAMPTON MA
01060-2056
US

IV. Provider business mailing address

193 LOCUST ST
NORTHAMPTON MA
01060-2056
US

V. Phone/Fax

Practice location:
  • Phone: 413-517-2226
  • Fax: 413-584-1714
Mailing address:
  • Phone: 413-517-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2010021085
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2007017251
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1015398
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: