Provider Demographics
NPI:1689761959
Name:MUGG, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:MUGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 LYMAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2352
Mailing Address - Country:US
Mailing Address - Phone:413-533-7176
Mailing Address - Fax:413-552-0181
Practice Address - Street 1:96 LYMAN ST
Practice Address - Street 2:
Practice Address - City:SO HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075
Practice Address - Country:US
Practice Address - Phone:413-533-7176
Practice Address - Fax:413-552-0181
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0158992Medicaid
MA0158992Medicaid
MA42MUH06010Medicare ID - Type Unspecified