Healthcare Provider Details

I. General information

NPI: 1629031448
Provider Name (Legal Business Name): HOWARD G TRIETSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 MAIN ST STE C
SPRINGFIELD MA
01107-1187
US

IV. Provider business mailing address

22 LOWER COVE RD
WARE MA
01082-9484
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-8484
  • Fax: 413-794-8477
Mailing address:
  • Phone: 413-237-2323
  • Fax: 413-794-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number55382
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: