MEDICARE: MS. JENNIFER L SAMALE PAC

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	363A00000X	Physician Assistant	1441	MA

General Provider Information

NPI Number	:	1154391597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER L SAMALE PAC

Provider Business Mailing Address
First Line	:	280 CHESTNUT ST
Second Line	:	2ND FL
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-1619
Country	:	US
Telephone Number	:	413-794-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 PLAINFIELD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01107-1524
Country	:	US
Telephone Number	:	413-794-4458
Fax Number	:	413-794-5131

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/17/2011

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