Provider Demographics
NPI:1881615532
Name:VASCULAR SERVICES OF WESTERN NEW ENGLAND, PC
Entity type:Organization
Organization Name:VASCULAR SERVICES OF WESTERN NEW ENGLAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-784-0900
Mailing Address - Street 1:3500 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1110
Mailing Address - Country:US
Mailing Address - Phone:413-784-0900
Mailing Address - Fax:413-781-5035
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 226
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2458
Practice Address - Country:US
Practice Address - Phone:413-736-4391
Practice Address - Fax:413-736-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9784187Medicaid
M20565Medicare ID - Type Unspecified