Healthcare Provider Details

I. General information

NPI: 1871501858
Provider Name (Legal Business Name): ALAN R GRAICHEN PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 STATE ROAD
WHATELY MA
01093
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FLOOR
SPRINGFIELD MA
01199
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-8517
  • Fax: 413-665-8741
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number158
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: