Healthcare Provider Details

I. General information

NPI: 1508967456
Provider Name (Legal Business Name): VERONICA O DEYESO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 SOUTH ST
PITTSFIELD MA
01201
US

IV. Provider business mailing address

261 SOUTH ST
PITTSFIELD MA
01201-6810
US

V. Phone/Fax

Practice location:
  • Phone: 413-443-9082
  • Fax: 413-443-0361
Mailing address:
  • Phone: 413-443-9082
  • Fax: 413-443-0361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number50760
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: