Healthcare Provider Details

I. General information

NPI: 1750370201
Provider Name (Legal Business Name): MORRIS EARLE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOCUST ST
NORTHAMPTON MA
01060-2052
US

IV. Provider business mailing address

30 LOCUST ST
NORTHAMPTON MA
01060-2052
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-2792
  • Fax: 413-582-4675
Mailing address:
  • Phone: 413-582-2792
  • Fax: 413-582-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number57034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: