MEDICARE: MARIA THERESA CURTIN-MCKENNA

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

General Provider Information

NPI Number	:	1831448067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA THERESA CURTIN-MCKENNA

Provider Business Mailing Address
First Line	:	50 MAPLE ST
Second Line	:	3RD FLOOR
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1979
Country	:	US
Telephone Number	:	413-794-9816
Fax Number	:	413-794-4945

Provider Business Practice Location Address
First Line	:	50 MAPLE ST
Second Line	:	3RD FLOOR
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1979
Country	:	US
Telephone Number	:	413-794-9816
Fax Number	:	413-794-4945

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

Provider Enumeration Date	:	09/04/2012
Last Update Date	:	09/04/2012

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