MEDICARE: ANTHONY CHARLES SZOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		MA

General Provider Information

NPI Number	:	1144694209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY CHARLES SZOL

Provider Business Mailing Address
First Line	:	75 UPPER CHURCH ST
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-3173
Country	:	US
Telephone Number	:	413-539-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 UPPER CHURCH ST
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-3173
Country	:	US
Telephone Number	:	413-539-3560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	11/30/2015

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