Provider Demographics
NPI:1629042718
Name:PIONEER VALLEY CARDIOLOGY, P.C.
Entity Type:Organization
Organization Name:PIONEER VALLEY CARDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHUSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-781-5735
Mailing Address - Street 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1270
Mailing Address - Country:US
Mailing Address - Phone:413-781-5735
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 410
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-781-5735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9701621Medicaid
MA9701621Medicaid