Healthcare Provider Details

I. General information

NPI: 1689659757
Provider Name (Legal Business Name): CARLOS C MARAMAG JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST
PITTSFIELD MA
01201-4132
US

IV. Provider business mailing address

100 NORTH ST SUITE 413
PITTSFIELD MA
01201-5109
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-2555
  • Fax: 413-443-7039
Mailing address:
  • Phone: 413-447-2555
  • Fax: 413-443-7039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number225100
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: