Provider Demographics
NPI:1275593758
Name:INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-786-4700
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:377 WALNUT STREET EXTENSION
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001
Mailing Address - Country:US
Mailing Address - Phone:413-786-7217
Mailing Address - Fax:413-786-7219
Practice Address - Street 1:377 WALNUT STREET EXTENSION
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001
Practice Address - Country:US
Practice Address - Phone:413-786-7217
Practice Address - Fax:413-786-7219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAINM12149OtherBCBS MA
MAINM12149OtherBCBS MA