Basic Information
| Provider Information | |||||||||
| NPI: | 1780659656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAUSEL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 61137 | ||||||||
| Address2: | |||||||||
| City: | LONG MEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011166137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132147435 | ||||||||
| FaxNumber: | 4132147436 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 LOWER WESTFIELD RD | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010402747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135253958 | ||||||||
| FaxNumber: | 4135253943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 33909 | MA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | N51561 | 01 | MA | B/S | OTHER | 0104949 | 05 | MA | MEDICAID |