Healthcare Provider Details

I. General information

NPI: 1811442270
Provider Name (Legal Business Name): MR. ROWAN DANIEL PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108A N MAIN ST
SUNDERLAND MA
01375-9502
US

IV. Provider business mailing address

47 ORCHARD ST
NORTHAMPTON MA
01060-2324
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-8717
  • Fax:
Mailing address:
  • Phone: 413-727-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: