MEDICARE: INTERNAL MEDICINE PC

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	INM12149	OTHER	MA	BCBS MA

General Provider Information

NPI Number	:	1275593758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE PC

Provider Business Mailing Address
First Line	:	PO BOX 788
Second Line	:	377 WALNUT STREET EXTENSION
City	:	AGAWAM
State	:	MA
Zip	:	01001
Country	:	US
Telephone Number	:	413-786-7217
Fax Number	:	413-786-7219

Provider Business Practice Location Address
First Line	:	377 WALNUT STREET EXTENSION
Second Line	:
City	:	AGAWAM
State	:	MA
Zip	:	01001
Country	:	US
Telephone Number	:	413-786-7217
Fax Number	:	413-786-7219

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	MS. LYNN A MCDONALD
Credential	:
Telephone Number	:	413-786-4700

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/22/2020

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Directions to “INTERNAL MEDICINE PC ” Practice Location

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