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General NPI Number Information
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NPI Number | 1750596201
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Entity Type | Organization
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Legal Business Name | NORTHERN BERKSHIRE PEDIATRICS, LLP
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 77 HOSPITAL AVE. SUITE 302
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City | NORTH ADAMS
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State | MA
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Zip | 01247-2538
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Country | US
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Telephone | 413-663-8365
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Fax | 413-662-2363
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Provider Business Mailing Address
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Address Line | 77 HOSPITAL AVE., SUITE 302 AMBULATORY CARE CENTER
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City | NORTH ADAMS
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State | MA
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Zip | 01247-2538
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Country | US
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Telephone | 413-663-8365
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Fax | 413-662-2363
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SUSAN KING
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Credential |
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Telephone | 413-663-8365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | MA
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