Healthcare Provider Details

I. General information

NPI: 1609430792
Provider Name (Legal Business Name): AFC PHYSICIANS OF MASSACHUSETTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 COOLEY ST
SPRINGFIELD MA
01128
US

IV. Provider business mailing address

136 DWIGHT RD
LONGMEADOW MA
01106
US

V. Phone/Fax

Practice location:
  • Phone: 413-782-4878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES BRENNAN
Title or Position: MANAGER
Credential:
Phone: 413-565-3181