Provider Demographics
NPI:1003981291
Name:GALAVOTTI, CYNTHIA M (DPM)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:GALAVOTTI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:594 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036-9107
Mailing Address - Country:US
Mailing Address - Phone:413-566-3255
Mailing Address - Fax:
Practice Address - Street 1:594 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:MA
Practice Address - Zip Code:01036-9107
Practice Address - Country:US
Practice Address - Phone:413-566-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2189213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94868Medicare UPIN
Y7512401Medicare PIN