Healthcare Provider Details

I. General information

NPI: 1689729857
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF HAMPDEN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 PARK ST
WEST SPRINGFIELD MA
01089-3304
US

IV. Provider business mailing address

373 PARK ST
WEST SPRINGFIELD MA
01089-3304
US

V. Phone/Fax

Practice location:
  • Phone: 413-734-1001
  • Fax: 413-736-4875
Mailing address:
  • Phone: 413-734-1001
  • Fax: 413-736-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: MICHAEL S FREEDMAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 413-734-1001