Provider Demographics
NPI:1558338954
Name:FINE, JOAN S (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:S
Last Name:FINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:2006-03-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA52269208000000X, 2080A0000X
CT039117208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6184928Medicaid
MAF23539Medicare UPIN