Provider Demographics
NPI:1184613630
Name:SPLAIN, JAMES L (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:SPLAIN
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 1:230 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1838
Mailing Address - Country:US
Mailing Address - Phone:413-789-6800
Mailing Address - Fax:413-598-7876
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1838
Practice Address - Country:US
Practice Address - Phone:413-789-6800
Practice Address - Fax:413-598-7876
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237874208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110080070/AMedicaid
F62588Medicare UPIN
MA110080070/AMedicaid