Basic Information
| Provider Information | |||||||||
| NPI: | 1285634170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANN | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8019 | ||||||||
| Address2: | VALLEY MEDICAL GROUP, PC | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011028000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664314077 | ||||||||
| FaxNumber: | 4137747448 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 HALL DR | ||||||||
| Address2: | AMHERST MEDICAL CENTER | ||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010022751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132568561 | ||||||||
| FaxNumber: | 4132564421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 54868 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 710700 | 01 | MA | HPHC | OTHER | 102720 | 01 | MA | CIGNA | OTHER | 24212 | 01 | MA | HNE | OTHER | 054868 | 01 | MA | TUFTS | OTHER | 6197809 | 05 | MA | MEDICAID | J04703 | 01 | MA | BLUE CROSS & BLUE SHIELD | OTHER | 000000008361 | 01 | MA | BMC | OTHER | 2345700 | 01 | MA | AETNA | OTHER | 2211723 03 | 01 | MA | UNITED HEALTH CARE | OTHER | 1293472 | 01 | MA | FALLON | OTHER |