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General NPI Number Information
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NPI Number | 1659533552
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Entity Type | Organization
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Legal Business Name | SAMUEL GLADSTONE, MD
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 12 DICKINSON ST
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City | AMHERST
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State | MA
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Zip | 01002-2310
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Country | US
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Telephone | 413-253-2300
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Fax | 413-256-0464
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Provider Business Mailing Address
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Address Line | 12 DICKINSON ST
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City | AMHERST
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State | MA
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Zip | 01002-2310
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Country | US
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Telephone | 413-253-2300
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Fax | 413-256-0464
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | SAMUEL GLADSTONE
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Credential | MD
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Telephone | 413-253-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 55035
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License Number State | MA
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