Basic Information
| Provider Information | |||||||||
| NPI: | 1578586582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHAMPTON AREA PEDIATRICS, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 193 LOCUST ST | ||||||||
| Address2: | #2 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135848700 | ||||||||
| FaxNumber: | 4135841714 | ||||||||
| Practice Location | |||||||||
| Address1: | 193 LOCUST ST | ||||||||
| Address2: | #2 | ||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135848700 | ||||||||
| FaxNumber: | 4135841714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | KENNY | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4135848700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | 208000000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 9773126 | 05 | MA | MEDICAID |