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General NPI Number Information
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NPI Number | 1306914601
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Entity Type | Organization
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Legal Business Name | ELM STREET ADULT MEDICINE, P.C.
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 264 ELM ST SUITES 10 & 12
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2857
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Country | US
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Telephone | 413-586-1100
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Fax | 413-584-7062
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Provider Business Mailing Address
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Address Line | 264 ELM ST SUITES 10 & 12
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2857
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Country | US
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Telephone | 413-586-1100
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Fax | 413-584-7062
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | EDWARD M DEAN
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Credential | M.D.
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Telephone | 413-586-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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