Provider Demographics
NPI:1003930728
Name:ALLCROFT FACIAL PLASTIC SURGERY, PC
Entity Type:Organization
Organization Name:ALLCROFT FACIAL PLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-582-2656
Mailing Address - Street 1:163 CONZ ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3848
Mailing Address - Country:US
Mailing Address - Phone:413-586-3200
Mailing Address - Fax:413-587-0970
Practice Address - Street 1:163 CONZ ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3848
Practice Address - Country:US
Practice Address - Phone:413-586-3200
Practice Address - Fax:413-587-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21494Medicare PIN