Healthcare Provider Details

I. General information

NPI: 1629171830
Provider Name (Legal Business Name): PHILLIP ANTHONY CARPINO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST
SPRINGFIELD MA
01107
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01104-3563
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-5550
  • Fax:
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number266
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: