1104863844 NPI number — RICHARD H BRODY M.D.

Table of content: RICHARD H BRODY M.D. (NPI 1104863844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104863844 NPI number — RICHARD H BRODY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRODY
Provider First Name:
RICHARD
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1104863844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 N MAIN ST
Provider Second Line Business Mailing Address:
STE 5
Provider Business Mailing Address City Name:
EAST LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01028-2392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-525-6003
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N MAIN ST
Provider Second Line Business Practice Location Address:
SOUTH BUILDING, STE 4, UNIT 5
Provider Business Practice Location Address City Name:
E LONGMEADOW
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-348-8007
Provider Business Practice Location Address Fax Number:
413-634-1751
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  60568 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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