Provider Demographics
NPI:1063484038
Name:IVERSON, PATRICIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:IVERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 CONWAY ST
Mailing Address - Street 2:VALLEY MEDICAL GROUP, PC-GREENFIELD HEALTH CENTER
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301
Mailing Address - Country:US
Mailing Address - Phone:413-774-6301
Mailing Address - Fax:866-644-0871
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:VALLEY MEDICAL GROUP, PC-GREENFIELD HEALTH CENTER
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301
Practice Address - Country:US
Practice Address - Phone:413-774-6301
Practice Address - Fax:866-644-0871
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA71162OtherHARVARD PILGRIM HEALTH
MA060263OtherTUFTS HEALTH PLAN
MA13324OtherHEALTH NEW ENGLAND
MAJ06299OtherBLUE CROSS BLUE SHIELD OF
MA3017664Medicaid
MAA59066Medicare UPIN
MA13324OtherHEALTH NEW ENGLAND
MAJ06299Medicare PIN