Provider Demographics
NPI:1912006065
Name:NILSSON, CLAES M (MD)
Entity Type:Individual
Prefix:
First Name:CLAES
Middle Name:M
Last Name:NILSSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:819 WORCESTER ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1045
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:413-543-7962
Practice Address - Street 1:990 WASHINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6714
Practice Address - Country:US
Practice Address - Phone:413-543-6820
Practice Address - Fax:781-326-1384
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-10-19
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Provider Licenses
StateLicense IDTaxonomies
MA53091207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110045324/AMedicaid
MAJ03301Medicare PIN
MA110045324/AMedicaid