Individual
DR. DAVID R FANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 BIRNIE AVE, STE 102, SPRINGFIELD, MA 01107
(413) 734-4206
(413) 737-8882
Mailing address
300 BIRNIE AVE, STE 102, SPRINGFIELD, MA 01107
(413) 734-4206
(413) 737-8882
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
54869
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3018075
—
MA
01
—
J05825
BCBS
MA
Enumeration date
08/19/2005
Last updated
04/16/2008
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