Provider Demographics
NPI:1801884721
Name:WESTERN MASSACHUSETTS PODIATRY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:WESTERN MASSACHUSETTS PODIATRY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CWASS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:413-525-4373
Mailing Address - Street 1:264 N MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1815
Mailing Address - Country:US
Mailing Address - Phone:413-525-4373
Mailing Address - Fax:413-525-9098
Practice Address - Street 1:264 N MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1815
Practice Address - Country:US
Practice Address - Phone:413-525-4373
Practice Address - Fax:413-525-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2189213E00000X
MA2038213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0473370001Medicare NSC
Y78014Medicare UPIN