| Green Mountain Neurology, Inc | |
|
777 North St Suite 205 Pittsfield MA 01201-4147 | |
| (413) 395-7517 | |
| (413) 395-7518 |
| Full Name | Green Mountain Neurology, Inc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 777 North St, Pittsfield, Massachusetts |
| Authorized Official Name and Position | Alexander S Kloman (PRESIDENT) |
| Authorized Official Contact | 4133957517 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Mountain Neurology, Inc 777 North St Suite 205 Pittsfield MA 01201-4147 Ph: (413) 395-7517 | Green Mountain Neurology, Inc 777 North St Suite 205 Pittsfield MA 01201-4147 Ph: (413) 395-7517 |
| NPI Number | 1427255538 |
|---|---|
| Provider Enumeration Date | 07/02/2007 |
| Last Update Date | 02/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427255538 | NPI | - | NPPES |
| 22838 | Other | MA | BMC HEALTH NET |
| 9730541 | Medicaid | MA | |
| 990894 | Other | MA | MVP IND # |
| 18776 | Other | MA | HNE |
| M17766 | Other | MA | MASS BCBS GRP # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 71916 (Massachusetts) | Primary |
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | 71916 (Massachusetts) | Secondary |
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