Basic Information
| Provider Information | |||||||||
| NPI: | 1952302986 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SPIRO | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 NEW LUDLOW RD | ||||||||
| Address2: | WESTERN MASS PHYSICIAN ASSOCIATES INC | ||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010204324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135333470 | ||||||||
| FaxNumber: | 4135336859 | ||||||||
| Practice Location | |||||||||
| Address1: | 247 CABOT ST | ||||||||
| Address2: | WESTERN MASS PEDIATRICS-CARE CENTER | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010403927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135322900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 206257 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0325741 | 05 | MA | MEDICAID |