Basic Information
| Provider Information | |||||||||
| NPI: | 1568439818 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLYOKE PEDIATRIC ASSOCIATES, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 LOWER WESTFIELD RD | ||||||||
| Address2: | STE1 | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010402767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135362393 | ||||||||
| FaxNumber: | 4135361087 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 LOWER WESTFIELD RD | ||||||||
| Address2: | STE1 | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010402767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135362393 | ||||||||
| FaxNumber: | 4135361087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | DUQUETTE | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 4133130236 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 9703942 | 05 | MA | MEDICAID |