Provider Demographics
NPI:1619962537
Name:PEGELS, JANICE JOY (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:JOY
Last Name:PEGELS
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 1:395 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3914
Mailing Address - Country:US
Mailing Address - Phone:413-584-7787
Mailing Address - Fax:413-584-7778
Practice Address - Street 1:395 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3914
Practice Address - Country:US
Practice Address - Phone:413-584-7787
Practice Address - Fax:413-584-7778
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400264847Medicare UPIN
NYDD4189Medicare PIN