1942605373 NPI number — CD PRACTICE ASSOCIATES, INC

Table of content: (NPI 1942605373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942605373 NPI number — CD PRACTICE ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CD PRACTICE ASSOCIATES, INC
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:
6
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:
1942605373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 LOCUST ST
Provider Second Line Business Mailing Address:
COOLEY DICKINSON MEDICAL GROUP
Provider Business Mailing Address City Name:
NORTHAMPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01060-2052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-582-2898
Provider Business Mailing Address Fax Number:
413-582-2958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ATWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-4272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-582-2175
Provider Business Practice Location Address Fax Number:
413-923-9322
Provider Enumeration Date:
10/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
STACHELEK
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
413-582-2653

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , 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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