Basic Information
| Provider Information | |||||||||
| NPI: | 1689696924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICKEY | ||||||||
| FirstName: | JEFFERSON | ||||||||
| MiddleName: | HALEY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 262 NEW LUDLOW ROAD | ||||||||
| Address2: | CHICOPEE MEDICAL CENTER | ||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135523250 | ||||||||
| FaxNumber: | 4135523255 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 NEW LUDLOW ROAD | ||||||||
| Address2: | WESTERN MASS PHYSICIAN ASSOCIATES, INC. | ||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135342622 | ||||||||
| FaxNumber: | 4135342661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 10/31/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 75064 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110092205A | 05 | MA | MEDICAID |