Individual
MR. LOUIS PATRICK FAVATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
140 HIGH ST., SPRINGFIELD, MA 01199
(413) 794-2511
(413) 794-2272
Mailing address
280 CHESTNUT ST., SPRINGFIELD, MA 01199
(413) 794-5700
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1505
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1505
LIC
MA
Enumeration date
01/19/2006
Last updated
03/03/2010
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