Provider Demographics
NPI:1780694075
Name:PRYJMA, PHILIP J (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:PRYJMA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-447-2000
Mailing Address - Fax:413-447-2176
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-447-2000
Practice Address - Fax:413-447-2176
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA380802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3031209Medicaid
A55742Medicare UPIN
MA3031209Medicaid