Provider Demographics
NPI:1376528638
Name:DEAN, EDWARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:DEAN
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 1:264 ELM ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2857
Mailing Address - Country:US
Mailing Address - Phone:413-586-1100
Mailing Address - Fax:413-584-7062
Practice Address - Street 1:264 ELM ST
Practice Address - Street 2:SUITE 10
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2857
Practice Address - Country:US
Practice Address - Phone:413-586-1100
Practice Address - Fax:413-584-7062
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA070667OtherTUFTS HEALTHPLAN
MA2863554OtherAETNA HEALTHCARE
MA370667OtherCONNECTICARE
MAE50266OtherHARVARD PILGRIM HEALTHPLA
MA0000000022860OtherBMC HEALTHNET
MA0196355Medicaid
MAJ09808OtherBC & BS OF MASSACHUSETTS
MA20126OtherHEALTH NEW ENGLAND
MA0000000022860OtherBMC HEALTHNET
MAE50266Medicare UPIN