Basic Information
Provider Information
NPI: 1003298753
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RADE
FirstName: MATTHEW
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 280 CHESTNUT ST FL 2
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011991001
CountryCode: US
TelephoneNumber: 4137945700
FaxNumber:  
Practice Location
Address1: 2 MEDICAL CENTER DR STE 308
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011071271
CountryCode: US
TelephoneNumber: 7817448585
FaxNumber: 4137942670
Other Information
ProviderEnumerationDate: 06/18/2015
LastUpdateDate: 09/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X283771MAY Allopathic & Osteopathic PhysiciansSurgery 
390200000X263975MAN Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


Home