Provider Demographics
NPI:1568439818
Name:HOLYOKE PEDIATRIC ASSOCIATES, LLP
Entity Type:Organization
Organization Name:HOLYOKE PEDIATRIC ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-313-0236
Mailing Address - Street 1:150 LOWER WESTFIELD RD
Mailing Address - Street 2:STE1
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2767
Mailing Address - Country:US
Mailing Address - Phone:413-536-2393
Mailing Address - Fax:413-536-1087
Practice Address - Street 1:150 LOWER WESTFIELD RD
Practice Address - Street 2:STE1
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2767
Practice Address - Country:US
Practice Address - Phone:413-536-2393
Practice Address - Fax:413-536-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9703942Medicaid
M10991Medicare PIN