Basic Information
| Provider Information | |||||||||
| NPI: | 1265745350 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAPLES OPPERMAN | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | STAPLES | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 55 PITTSFIELD LENOX RD | ||||||||
| Address2: | LENOX COMMONS, STE 12D | ||||||||
| City: | LENOX | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012402123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133441700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 55 PITTSFIELD LENOX RD | ||||||||
| Address2: | LENOX COMMONS, STE 12D | ||||||||
| City: | LENOX | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012402123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133441700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2010 | ||||||||
| LastUpdateDate: | 06/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 245125 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 259759 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.