=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285634170
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN K DANN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2005
-----------------------------------------------------
Last Update Date | 06/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 HALL DR AMHERST MEDICAL CENTER
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01002-2751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-256-8561
-----------------------------------------------------
Fax | 413-256-4421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8019 VALLEY MEDICAL GROUP, PC
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01102-8000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-431-4077
-----------------------------------------------------
Fax | 413-774-7448
-----------------------------------------------------
=====================================================
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 | 54868
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------