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General NPI Number Information
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NPI Number | 1871015750
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Entity Type | Organization
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Legal Business Name | HEATHER WARK MD LLC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 548 ELM ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2832
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Country | US
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Telephone | 413-586-2832
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Fax |
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Provider Business Mailing Address
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Address Line | 145 VERNON ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER WARK
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Credential | MD
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Telephone | 413-237-4933
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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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