=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922009547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTERN MASS PHYSICIAN ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 262 NEW LUDLOW RD
-----------------------------------------------------
City | CHICOPEE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01020-4324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-534-2622
-----------------------------------------------------
Fax | 413-534-2661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 HOSPITAL DR WESTERN MASS PHYSICIAN ASSOCIATES, INC.
-----------------------------------------------------
City | HOLYOKE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01040-6606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-533-3470
-----------------------------------------------------
Fax | 413-533-6859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF AMBULATORY SERVICES
-----------------------------------------------------
Name | MR. PHILLIP CANDITO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 413-534-2622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------