Provider Demographics
NPI:1093839805
Name:VALLEY MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:VALLEY MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-774-6301
Mailing Address - Street 1:PO BOX 5700
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:31 HALL DR STE 1
Practice Address - Street 2:AMHERST MEDICAL CENTER
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2778
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:413-256-4419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY MEDICAL GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4607810003Medicare NSC