Organization
SURGICAL SPECIALISTS OF WESTERN NEW ENGLAND PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT D FANELLI MD (PRESIDENT)
(413) 442-2462
Entity
Organization
Contact information
Practice address
510 NORTH STREET SUITE 202, PITTSFIELD, MA 01201
(413) 442-2462
(413) 442-3101
Mailing address
510 NORTH ST, SUITE 202, PITTSFIELD, MA 01201-4111
(413) 442-2462
(413) 442-3101
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9703675
—
MA
01
—
M12867
BLUE SHIELD
MA
Enumeration date
08/16/2006
Last updated
02/11/2009
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