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General NPI Number Information
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NPI Number | 1730263039
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Entity Type | Organization
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Legal Business Name | UROLOGY GROUP OF WESTERN NEW ENGLAND, P.C.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 3640 MAIN ST SUITE 103
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1145
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Country | US
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Telephone | 413-785-5321
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Fax | 413-731-7130
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Provider Business Mailing Address
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Address Line | 3640 MAIN ST SUITE 103
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1145
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Country | US
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Telephone | 413-785-5321
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Fax | 413-731-7130
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMMAD R MOSTAFAVI
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Credential | M.D.
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Telephone | 413-785-5321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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