Basic Information
| Provider Information | |||||||||
| NPI: | 1164422432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PO | ||||||||
| FirstName: | LORENVER | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 HOSPITAL DR. | ||||||||
| Address2: | WESTERN MASS PHYSICIAN ASSOCIATES INC | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135333470 | ||||||||
| FaxNumber: | 4135336859 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 HOSPITAL DR SUITE 101 | ||||||||
| Address2: | HOLYOKE ASSOCIATES IN INTERNAL MEDICINE | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135368924 | ||||||||
| FaxNumber: | 4135329141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 04/09/2010 | ||||||||
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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 | 207R00000X | 215625 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 692919 | 01 | HARVARD PILGRIM | OTHER | J25173 | 01 | BC/BS OF MASS | OTHER | 0195511 | 05 | MA | MEDICAID | 043202198 | 01 | HMC - PPO | OTHER | 110246843 | 01 | MA | MEDICARE RAILROAD | OTHER | 6439469001 | 01 | CIGNA | OTHER | 043202198 | 01 | BEECH STREET | OTHER | 043202198 | 01 | FIRST HEALTH | OTHER | 043202198 | 01 | MULTI-PLAN | OTHER | 043202198012 | 01 | TRICARE | OTHER | J25173 | 01 | HMO BLUE | OTHER | 215625 | 01 | CONNECTICARE OF MA | OTHER | 043202198 | 01 | GREAT WEST HEALTH PLAN | OTHER | 043202198 | 01 | CONSOLIDATED HEALTH PLAN | OTHER | 975688 | 01 | NETWORK HEALTH | OTHER | 000000023253 | 01 | BOSTON MEDICAL CENTER HNP | OTHER | 043202198 | 01 | HEALTH CARE VALUE MGMT | OTHER | 30889 | 01 | HEALTH NEW ENGLAND | OTHER |