Organization
GREEN MOUNTAIN NEUROLOGY, INC
Active
Organization
GREEN MOUNTAIN NEUROLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER S KLOMAN MD (PRESIDENT)
(413) 395-7517
Entity
Organization
Contact information
Practice address
777 NORTH ST, SUITE 205, PITTSFIELD, MA 01201-4147
(413) 395-7517
(413) 395-7518
Mailing address
777 NORTH ST, SUITE 205, PITTSFIELD, MA 01201-4147
(413) 395-7517
(413) 395-7518
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
71916
MA
2084N0600X
Clinical Neurophysiology Physician
71916
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18776
HNE
MA
01
—
22838
BMC HEALTH NET
MA
05
—
9730541
—
MA
01
—
990894
MVP IND #
MA
01
—
M17766
MASS BCBS GRP #
MA
Enumeration date
07/02/2007
Last updated
02/25/2016
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