Provider Demographics
NPI:1649273970
Name:MIGDOW, JEFFREY ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ARTHUR
Last Name:MIGDOW
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:PO BOX 2372
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-5372
Mailing Address - Country:US
Mailing Address - Phone:413-637-1513
Mailing Address - Fax:413-448-3384
Practice Address - Street 1:56 HOUSATONIC ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2637
Practice Address - Country:US
Practice Address - Phone:413-637-1513
Practice Address - Fax:413-448-3384
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02573Medicare ID - Type UnspecifiedMEDICARE
MAJ02573Medicare UPIN