Provider Demographics
NPI:1750366381
Name:D'AGOSTINO, CHARLES ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROSS
Last Name:D'AGOSTINO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1565 HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-3029
Mailing Address - Country:US
Mailing Address - Phone:413-442-4700
Mailing Address - Fax:413-442-4711
Practice Address - Street 1:1450 EAST ST
Practice Address - Street 2:SUITE 6N
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5319
Practice Address - Country:US
Practice Address - Phone:413-442-4700
Practice Address - Fax:413-442-4711
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-10-11
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Provider Licenses
StateLicense IDTaxonomies
MA156843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A28440Medicare PIN