Provider Demographics
NPI:1629095294
Name:FLACK, JOSEPH E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:FLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1300 HALL BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2918
Mailing Address - Country:US
Mailing Address - Phone:860-714-9137
Mailing Address - Fax:860-714-8610
Practice Address - Street 1:444 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1969
Practice Address - Country:US
Practice Address - Phone:413-594-3111
Practice Address - Fax:413-598-7014
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70671208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110047053AMedicaid
MAE14163Medicare UPIN
MA330001976OtherRAILROAD MEDICARE
MA12387OtherHEALTH NEW ENGLAND
MAJ08702OtherBLUE CROSS BLUE SHIELD
MA484158OtherCONNECTICARE
MA070671OtherTUFTS
MA0013239OtherNEIGHBORHOOD HEALTH PLAN
MAJ08702Medicare PIN
MA3048829Medicaid
MA000000023446OtherBMC-HEALTHNET