Individual
SAMANTHA WHALEN BOUTHILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 BIRNIE AVE, SPRINGFIELD, MA 01107-1107
(413) 785-4666
Mailing address
75 RUSSELLVILLE RD, SOUTHAMPTON, MA 01073-9508
(413) 454-2782
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA5512
MA
363AS0400X
Surgical Physician Assistant
2833
CT
363AS0400X
Surgical Physician Assistant
Primary
PA5512
MA
Other
Enumeration date
09/27/2012
Last updated
03/03/2026
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