=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063484038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA A IVERSON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2006
-----------------------------------------------------
Last Update Date | 04/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 329 CONWAY ST VALLEY MEDICAL GROUP, PC-GREENFIELD HEALTH CENTER
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-774-6301
-----------------------------------------------------
Fax | 866-644-0871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 329 CONWAY ST VALLEY MEDICAL GROUP, PC-GREENFIELD HEALTH CENTER
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-774-6301
-----------------------------------------------------
Fax | 866-644-0871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 60263
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------