Basic Information
Provider Information
NPI: 1750571899
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VALANIA
FirstName: GREGORY
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 280 CHESTNUT ST
Address2: 2ND FLOOR
City: SPRINGFIELD
State: MA
PostalCode: 011991001
CountryCode: US
TelephoneNumber: 4137945700
FaxNumber:  
Practice Location
Address1: 3300 MAIN ST
Address2: 2ND FLOOR, SUITE A
City: SPRINGFIELD
State: MA
PostalCode: 011071112
CountryCode: US
TelephoneNumber: 4137942273
FaxNumber: 4137940198
Other Information
ProviderEnumerationDate: 07/25/2007
LastUpdateDate: 02/13/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X231925MAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RA0001X231925MAN    
207RC0000X231925MAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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