Basic Information
| Provider Information | |||||||||
| NPI: | 1114902848 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARB | ||||||||
| FirstName: | PERRY | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MONARCH PL | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011441099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137342000 | ||||||||
| FaxNumber: | 4137348000 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MONARCH PL | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011441099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137342000 | ||||||||
| FaxNumber: | 4137348000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 11/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 224137 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A38455 | 01 | MEDICARE B | OTHER | AA37972 | 01 | HARVARD PILGRIM | OTHER | 042472266 | 01 | UNITED HEALTHCARE | OTHER | 042472266 | 01 | TRICARE CHAMPUS | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE | OTHER | 38788 | 01 | FIRST HEALTH | OTHER | J29464 | 01 | BLUE CARE ELECT | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 2106329 | 05 | MA | MEDICAID | 305217 | 01 | TUFTS HEALTH PLAN | OTHER | 4025035 | 01 | CIGNA HEALTHSOURCE | OTHER | 4113555 | 01 | AETNA US HEALTHCARE | OTHER | 92432 | 01 | FALLON COMMUNITY HEALTH | OTHER |