Provider Demographics
NPI:1033278486
Name:EAST MOUNTAIN MEDICAL ASSOCIATES P C
Entity Type:Organization
Organization Name:EAST MOUNTAIN MEDICAL ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-528-2418
Mailing Address - Street 1:780 MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-2180
Mailing Address - Country:US
Mailing Address - Phone:413-528-2418
Mailing Address - Fax:413-528-2907
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2180
Practice Address - Country:US
Practice Address - Phone:413-528-2418
Practice Address - Fax:413-528-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9701524Medicaid
M20890Medicare ID - Type Unspecified