Healthcare Provider Details

I. General information

NPI: 1831388792
Provider Name (Legal Business Name): SPRINGFIELD PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW STREET SUITE 126 FIRST FLOOR
SPRINGFIELD MA
01104
US

IV. Provider business mailing address

299 CAREW STREET SUITE 126 FIRST FLOOR
SPRINGFIELD MA
01104
US

V. Phone/Fax

Practice location:
  • Phone: 413-747-5437
  • Fax: 413-747-5433
Mailing address:
  • Phone: 413-747-5437
  • Fax: 413-747-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier3140423
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: DR. MARIA ETHEL EVALES
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 413-747-5437