Basic Information
| Provider Information | |||||||||
| NPI: | 1902852205 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTFIELD EMERGENCY PHYSICIANS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 419218 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022419218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812801736 | ||||||||
| FaxNumber: | 6108342862 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 WEST SILVER STREET | ||||||||
| Address2: | BAYSTATE NOBLE HOSPITAL EMERGENCY DEPARTMENT | ||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135682811 | ||||||||
| FaxNumber: | 4135627896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 11/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | KHALEGHI | ||||||||
| AuthorizedOfficialFirstName: | MURDOC | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8584574523 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9785477 | 05 | MA | MEDICAID | 24890 | 01 | MA | HEALTHCARE NEW ENGLAND | OTHER | 103255000 | 01 | MA | US DEPARTMENT OF LABOR | OTHER | M17291 | 01 | MA | GROUP BLUE SHIELD NUMBER | OTHER | 000000021085 | 01 | MA | HEALTH NET PLAN | OTHER |