Provider Demographics
NPI:1174687966
Name:VALLEY MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:VALLEY MEDICAL GROUP, P.C.
Other - Org Name:VALLEY MEDICAL GROUP LABORATORY
Other - Org Type:Doing Business As
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 1:238 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1046
Mailing Address - Country:US
Mailing Address - Phone:413-772-3311
Mailing Address - Fax:413-527-1012
Practice Address - Street 1:238 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027
Practice Address - Country:US
Practice Address - Phone:413-772-3311
Practice Address - Fax:413-527-1012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY MEDICAL GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2535291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110070828GMedicaid
MA692254OtherTUFTS HEALTH PLAN
MA29362OtherHEALTH NEW ENGLAND
MATR0100Medicare PIN
MA29362OtherHEALTH NEW ENGLAND