Basic Information
Provider Information
NPI: 1205126273
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAFAIN
FirstName: GOLIEN
MiddleName: G
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 280 CHESTNUT ST
Address2: 2ND FLOOR
City: SPRINGFIELD
State: MA
PostalCode: 011991619
CountryCode: US
TelephoneNumber: 4137945700
FaxNumber:  
Practice Location
Address1: 759 CHESTNUT ST
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011991619
CountryCode: US
TelephoneNumber: 4137943233
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/12/2011
LastUpdateDate: 05/06/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X258094MAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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