Provider Demographics
NPI:1205315793
Name:WESTERN MASS PHYSICIAN ASSOCIATES INC
Entity type:Organization
Organization Name:WESTERN MASS PHYSICIAN ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF AMBULATORY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-534-2622
Mailing Address - Street 1:262 NEW LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4324
Mailing Address - Country:US
Mailing Address - Phone:413-534-2605
Mailing Address - Fax:413-534-2661
Practice Address - Street 1:1962 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020
Practice Address - Country:US
Practice Address - Phone:413-552-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-07
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty