1063484467 NPI number — GERIATRIC MEDICAL ASSOCIATES PC

Table of content: (NPI 1063484467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063484467 NPI number — GERIATRIC MEDICAL ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRIC MEDICAL ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063484467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 CHESTNUT ST
Provider Second Line Business Mailing Address:
SUITE 23
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01107-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-787-2800
Provider Business Mailing Address Fax Number:
413-787-2822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 23
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01107-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-787-2800
Provider Business Practice Location Address Fax Number:
413-787-2822
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
PAMELA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-787-2800

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 66697 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: M17556 . This is a "BCBS OF MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3370368 . This is a "AETNA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 724714J173 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00078010 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: M21439 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 691352 . This is a "TURFS SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: DA9195 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000023021 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".




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