Organization
PEDIATRIC GASTROENTEROLOGY & NUTRITION OF WESTERN MA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NONE NONE MD (PRESIDENT)
(800) 927-0002
Entity
Organization
Contact information
Practice address
2 MEDICAL CENTER DR, SPRINGFIELD, MA 01107-1270
(413) 733-4450
Mailing address
PO BOX 9132, BROOKLINE, MA 02446-9132
(800) 927-0002
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9710931
—
MA
Enumeration date
12/27/2005
Last updated
08/22/2020
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