Provider Demographics
NPI:1841230125
Name:KEROACK, CHRISTOPHER R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:KEROACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1270
Mailing Address - Country:US
Mailing Address - Phone:413-205-1200
Mailing Address - Fax:413-205-1220
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-205-1200
Practice Address - Fax:413-205-1220
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA160647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0113816Medicaid
MA0113816Medicaid
MAA31459Medicare ID - Type Unspecified