Basic Information
| Provider Information | |||||||||
| NPI: | 1326286998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIONEER VALLEY GASTROENTEROLOGY ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9132 | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024469132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009270002 | ||||||||
| FaxNumber: | 6038938886 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 HOSPITAL DR | ||||||||
| Address2: | SUITE # 102 | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010406603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135341132 | ||||||||
| FaxNumber: | 4135348166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2009 | ||||||||
| LastUpdateDate: | 09/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | CLIFFORD | ||||||||
| AuthorizedOfficialFirstName: | BERNARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4135341132 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.