Healthcare Provider Details

I. General information

NPI: 1164409272
Provider Name (Legal Business Name): PETER EVAN PASCAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W SILVER ST
WESTFIELD MA
01085-3628
US

IV. Provider business mailing address

115 W SILVER ST
WESTFIELD MA
01085-3628
US

V. Phone/Fax

Practice location:
  • Phone: 413-568-4637
  • Fax: 413-572-6011
Mailing address:
  • Phone: 413-568-4637
  • Fax: 413-572-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number029032
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12141
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number76028
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: