Provider Demographics
NPI:1609831197
Name:PROKHOROVA, NATALYA (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:
Last Name:PROKHOROVA
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 1:1040 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2107
Mailing Address - Country:US
Mailing Address - Phone:413-739-1100
Mailing Address - Fax:413-735-1133
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2107
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-735-1133
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223850208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000031647OtherHEALTHNET
MAAA36432OtherHARVARD PILGRIM
MA1310097Medicaid
MA967563OtherNETWORK HEALTH
MAJ28812OtherBC/BS
MAMP0591087AOtherCSR
MA2235976OtherCIGNA
MA0036480OtherNHP
223850OtherCONNECTICARE
MA36842OtherHNE
MA36842OtherHNE
MABP9090262OtherDEA
MAM21172Medicare PIN
MA221829Medicare Oscar/Certification