Basic Information
| Provider Information | |||||||||
| NPI: | 1093839805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY MEDICAL GROUP, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5700 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049155700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664314077 | ||||||||
| FaxNumber: | 4137747448 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 HALL DR STE 1 | ||||||||
| Address2: | AMHERST MEDICAL CENTER | ||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010022778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132568561 | ||||||||
| FaxNumber: | 4132564419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | CARLAN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4137746301 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VALLEY MEDICAL GROUP, P.C. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | MA | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.