Organization
MOUNTAIN MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTINE M DAGOSTINO (TREASURER)
(413) 442-4700
Entity
Organization
Contact information
Practice address
1450 EAST ST STE 6N, PITTSFIELD, MA 01201-5319
(413) 442-4700
(413) 442-4711
Mailing address
1565 HANCOCK RD, WILLIAMSTOWN, MA 01267
(413) 442-4700
(413) 442-4711
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000020879
BERKSHIRE HEALTH NET
—
01
—
000000028890
BMC HEALTH NET
—
01
—
1006517
VT MEDICAID
—
01
—
111654
MVP
—
01
—
11S654
MVP/PIN #
—
01
—
156843
TUFTS
—
01
—
16095
NHP
—
01
—
3183386
MASS HEALTH
—
05
—
3183386
—
MA
01
—
32023
HNE
—
01
—
3516813
AETNA
—
01
—
8906530002
CIGNA
—
01
—
J19130
MA BLUE SHIELD
—
01
—
MD0341139AR
MA CONTROL #
—
Enumeration date
05/03/2006
Last updated
10/10/2007
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