Healthcare Provider Details

I. General information

NPI: 1245634211
Provider Name (Legal Business Name): PRIMARY CARE MEDICINE AND PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 N ELM ST UNIT 206
WESTFIELD MA
01085-1647
US

IV. Provider business mailing address

94 N ELM ST UNIT 206
WESTFIELD MA
01085-1647
US

V. Phone/Fax

Practice location:
  • Phone: 413-562-1650
  • Fax: 413-562-1603
Mailing address:
  • Phone: 413-562-1650
  • Fax: 413-562-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RITA TROLIO
Title or Position: BILLING MANAGER
Credential:
Phone: 413-525-1611