Provider Demographics
NPI:1558338541
Name:GINSBURG, SALLY H (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:H
Last Name:GINSBURG
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 1:123 DWIGHT RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1748
Mailing Address - Country:US
Mailing Address - Phone:413-567-1031
Mailing Address - Fax:413-567-7683
Practice Address - Street 1:123 DWIGHT RD
Practice Address - Street 2:SUITE 11
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1748
Practice Address - Country:US
Practice Address - Phone:413-567-1031
Practice Address - Fax:413-567-7683
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152465208000000X
CT036262208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3175189Medicaid
MA3175189Medicaid