Healthcare Provider Details

I. General information

NPI: 1306750377
Provider Name (Legal Business Name): RENAL & TRANSPLANT ASSOC OF THE NORTHEAST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MAIN ST STE 204
SPRINGFIELD MA
01107-1078
US

IV. Provider business mailing address

3550 MAIN ST STE 204
SPRINGFIELD MA
01107-1078
US

V. Phone/Fax

Practice location:
  • Phone: 413-867-2500
  • Fax: 413-867-2555
Mailing address:
  • Phone: 413-867-2500
  • Fax: 413-867-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT SHAWN KILLIN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 413-867-2501