Organization
PIONEER VALLEY UROLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY GELLOCK (CREDENTIALING)
(413) 241-2100
Entity
Organization
Contact information
Practice address
100 WASON AVENUE, SUITE 120, SPRINGFIELD, MA 01107-0119
(413) 241-2100
(413) 735-2012
Mailing address
100 WASON AVENUE, SUITE 120, SPRINGFIELD, MA 01107-0119
(413) 241-2100
(413) 241-2100
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9774424
—
MA
01
—
M16033
BLUE CROSS OF MA
MA
Enumeration date
07/11/2006
Last updated
07/12/2010
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