Provider Demographics
NPI:1235390428
Name:PURI, BEATA ADELA (MD)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:ADELA
Last Name:PURI
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 1:477 SOUTHWICK RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4734
Mailing Address - Country:US
Mailing Address - Phone:413-562-5256
Mailing Address - Fax:413-568-4757
Practice Address - Street 1:477 SOUTHWICK RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4734
Practice Address - Country:US
Practice Address - Phone:413-562-5256
Practice Address - Fax:413-568-4757
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209180208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics