Provider Demographics
NPI:1265745350
Name:STAPLES OPPERMAN, AMANDA M (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:STAPLES OPPERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:STAPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:55 PITTSFIELD LENOX RD
Mailing Address - Street 2:LENOX COMMONS, STE 12D
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2123
Mailing Address - Country:US
Mailing Address - Phone:413-344-1700
Mailing Address - Fax:
Practice Address - Street 1:55 PITTSFIELD LENOX RD
Practice Address - Street 2:LENOX COMMONS, STE 12D
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2123
Practice Address - Country:US
Practice Address - Phone:413-344-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245125207R00000X
MA259759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine