Provider Demographics
NPI:1376068817
Name:PERSONAL PRIMARY CARE AND WEIGHT MANAGEMENT, LLC
Entity Type:Organization
Organization Name:PERSONAL PRIMARY CARE AND WEIGHT MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-846-3337
Mailing Address - Street 1:222 CAREW ST
Mailing Address - Street 2:STE. 301
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-4109
Mailing Address - Country:US
Mailing Address - Phone:413-732-4478
Mailing Address - Fax:413-732-7059
Practice Address - Street 1:299 CAREW ST STE 234
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2368
Practice Address - Country:US
Practice Address - Phone:413-787-2575
Practice Address - Fax:413-787-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-05
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty