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General NPI Number Information
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NPI Number | 1356507511
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Entity Type | Organization
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Legal Business Name | PREVENTIVE MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 98 SUFFOLK ST
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City | HOLYOKE
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State | MA
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Zip | 01040-4458
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Country | US
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Telephone | 413-540-9805
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Fax |
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Provider Business Mailing Address
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Address Line | 98 SUFFOLK ST
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City | HOLYOKE
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State | MA
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Zip | 01040-4458
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Country | US
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Telephone | 413-540-9805
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MS. MARY J DELONG
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Credential | MM, RHIA
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Telephone | 413-222-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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