Provider Demographics
NPI:1336125665
Name:LEDERMAN, HOWARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:C
Last Name:LEDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-2640
Mailing Address - Country:US
Mailing Address - Phone:413-727-3637
Mailing Address - Fax:413-439-9245
Practice Address - Street 1:233 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2377
Practice Address - Country:US
Practice Address - Phone:413-748-9212
Practice Address - Fax:413-439-9245
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81248208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3140971Medicaid
MAA20257Medicare ID - Type Unspecified
MA3140971Medicaid