Organization
INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYNN A MCDONALD (COMPTROLLER)
(413) 786-4700
Entity
Organization
Contact information
Practice address
377 WALNUT STREET EXTENSION, AGAWAM, MA 01001
(413) 786-7217
(413) 786-7219
Mailing address
PO BOX 788, 377 WALNUT STREET EXTENSION, AGAWAM, MA 01001
(413) 786-7217
(413) 786-7219
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
INM12149
BCBS MA
MA
Enumeration date
03/27/2006
Last updated
08/22/2020
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