Provider Demographics
NPI:1457345605
Name:RO, HOWARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:D
Last Name:RO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2150 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3300
Mailing Address - Country:US
Mailing Address - Phone:413-739-5676
Mailing Address - Fax:413-739-2278
Practice Address - Street 1:701 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2961
Practice Address - Country:US
Practice Address - Phone:860-741-6058
Practice Address - Fax:860-741-6864
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA154284207R00000X
CT040311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA30088OtherHEALTH NEW ENGLAND
MA2863931OtherAETNA HEALTH PLAN
CT0100403CT01OtherCT BCBS
MA1300237Medicaid
MA154284OtherTUFTS HEALTH PLAN
MAJ21208OtherMA BCBS
MA2863931OtherAETNA HEALTH PLAN
MA30088OtherHEALTH NEW ENGLAND