Healthcare Provider Details

I. General information

NPI: 1497567911
Provider Name (Legal Business Name): ISABELLA M PAPOUTSAKIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ISABELLA MATISSE DI LORENZO

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DR STE 503
SPRINGFIELD MA
01107-1273
US

IV. Provider business mailing address

280 CHESTNUT ST
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-5600
  • Fax: 413-794-5242
Mailing address:
  • Phone: 413-794-3909
  • Fax: 413-794-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA101499
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: