Healthcare Provider Details

I. General information

NPI: 1265460810
Provider Name (Legal Business Name): KERSTIN M SOBUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 CAREW ST
SPRINGFIELD MA
01104
US

IV. Provider business mailing address

516 CAREW ST
SPRINGFIELD MA
01104-2330
US

V. Phone/Fax

Practice location:
  • Phone: 413-787-2051
  • Fax: 413-787-2054
Mailing address:
  • Phone: 413-787-2051
  • Fax: 413-787-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number01061959
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number275036
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: