Healthcare Provider Details

I. General information

NPI: 1609831197
Provider Name (Legal Business Name): NATALYA PROKHOROVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 MAIN ST
SPRINGFIELD MA
01103-2107
US

IV. Provider business mailing address

1040 MAIN ST
SPRINGFIELD MA
01103-2107
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-1100
  • Fax: 413-735-1133
Mailing address:
  • Phone: 413-739-1100
  • Fax: 413-735-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number223850
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier000000031647
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHEALTHNET
# 2
IdentifierAA36432
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHARVARD PILGRIM
# 3
Identifier1310097
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 4
Identifier967563
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNETWORK HEALTH
# 5
IdentifierJ28812
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBC/BS
# 6
IdentifierMP0591087A
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCSR
# 7
Identifier2235976
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA
# 8
Identifier0036480
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNHP
# 9
Identifier223850
Identifier TypeOTHER
Identifier State
Identifier IssuerCONNECTICARE
# 10
Identifier36842
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: