Healthcare Provider Details

I. General information

NPI: 1568593044
Provider Name (Legal Business Name): CRAIG T VERMES PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN ST 3RD FL
SPRINGFIELD MA
01199-1002
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FL
SPRINGFIELD MA
01199-1000
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7020
  • Fax: 413-794-7201
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1148
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: