Provider Demographics
NPI:1912994187
Name:HINCKLEY, ALVAH V III (MD)
Entity Type:Individual
Prefix:
First Name:ALVAH
Middle Name:V
Last Name:HINCKLEY
Suffix:III
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 1:22 ATWOOD DR STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4267
Mailing Address - Country:US
Mailing Address - Phone:413-584-4637
Mailing Address - Fax:413-923-9320
Practice Address - Street 1:22 ATWOOD DR STE 203
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-4637
Practice Address - Fax:413-923-9320
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49319208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0163872Medicaid
MAG14126Medicare ID - Type Unspecified
MA0163872Medicaid