Healthcare Provider Details

I. General information

NPI: 1649319682
Provider Name (Legal Business Name): JOHN DAY DEWEESE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 CAREW ST
SPRINGFIELD MA
01104-2330
US

IV. Provider business mailing address

516 CAREW ST
SPRINGFIELD MA
01104-2330
US

V. Phone/Fax

Practice location:
  • Phone: 413-787-2000
  • Fax: 413-787-2012
Mailing address:
  • Phone: 413-787-2000
  • Fax: 413-787-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number35545
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: