Healthcare Provider Details

I. General information

NPI: 1639118722
Provider Name (Legal Business Name): JOELI HETTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT STREET
SPRINGFIELD MA
01199-1619
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FLOOR
SPRINGFIELD MA
01199-1619
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-3233
  • Fax:
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number159779
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number159779
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: