Basic Information
| Provider Information | |||||||||
| NPI: | 1912994815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCIARUTO | ||||||||
| FirstName: | DOMENICK | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 ROBERTS DR STE 313 | ||||||||
| Address2: | |||||||||
| City: | NORTH ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012473254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133985509 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135822363 | ||||||||
| FaxNumber: | 4135822914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 74916 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | 63938 | CT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04-3329195 | 01 | MA | NORTHEAST HEALTH DIRECT | OTHER | 04-3329195 | 01 | MA | GREAT-WEST HEALTH PLAN | OTHER | 04-3329195 | 01 | MA | PHCS | OTHER | AA38230 | 01 | MA | HARVARD PILGRIM | OTHER | J13367 | 01 | MA | BCBSMA | OTHER | 27760 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 04-3329195 | 01 | MA | COMMONWEALTH IND (UNICARE | OTHER | 30706 | 01 | MD | BMC | OTHER | 04-3329195 | 01 | MA | CONSOLIDATED HEALTH PLAN | OTHER | 347669 | 01 | MA | TUFTS | OTHER | 074916 | 01 | MA | CONNECTICARE | OTHER | 6424873 | 01 | MA | CIGNA | OTHER | 04-3329195 | 01 | MA | NORTHEAST HEALTHCARE ALLI | OTHER | 347669 | 01 | MA | AETNA | OTHER | 04-3329195 | 01 | MA | PLAN VISTA | OTHER | 04-3329195 | 01 | MA | NORTH AMERICAN PREFERRED | OTHER |