Healthcare Provider Details

I. General information

NPI: 1285053512
Provider Name (Legal Business Name): ADAM M. MIROT, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MYRON ST SUITE A
WEST SPRINGFIELD MA
01089-1598
US

IV. Provider business mailing address

103 MYRON ST SUITE A
WEST SPRINGFIELD MA
01089-1598
US

V. Phone/Fax

Practice location:
  • Phone: 413-592-1980
  • Fax:
Mailing address:
  • Phone: 413-592-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number79115
License Number StateMA

VIII. Authorized Official

Name: ADAM M MIROT
Title or Position: MANAGER
Credential: M.D.
Phone: 413-592-1980