Healthcare Provider Details

I. General information

NPI: 1114032315
Provider Name (Legal Business Name): DALE C PAPPAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CAREW ST STE 200
SPRINGFIELD MA
01104-2391
US

IV. Provider business mailing address

175 CAREW ST STE 200
SPRINGFIELD MA
01104-2391
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-4269
  • Fax: 413-785-4619
Mailing address:
  • Phone: 413-732-4269
  • Fax: 413-785-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1296
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1296
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: