Provider Demographics
NPI:1215132402
Name:CHOROWSKI, MAX (MD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:CHOROWSKI
Suffix:
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 1:123 DWIGHT RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1748
Mailing Address - Country:US
Mailing Address - Phone:413-374-9287
Mailing Address - Fax:
Practice Address - Street 1:123 DWIGHT RD STE 204
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1748
Practice Address - Country:US
Practice Address - Phone:413-374-9287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46072207VG0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0114774Medicaid
0452662003OtherCIGNA PAL ID
7U210OtherEMPIRE BC BS
N51732OtherBCBS GYN IND.
130408OtherHARVARD PILGRIM
CT17846OtherLICENSE #
789175OtherCONNECTICARE
MA9757139Medicaid
29397OtherCHILDREN'S MEDICAL SECURI
7906443OtherAETNA US HC PSYCH
0459212OtherAETNA US HC IND.
2082565OtherAETNA US HC GROUP
4210483OtherAETNA US GYN
MA46072OtherLISC # MA
M17234OtherBCBS PSYCHIATRY CORP
M14857OtherBCBS GROUP
V03951OtherBCBS PSYCH IND.
V03951OtherBCBS PSYCH IND.
2082565OtherAETNA US HC GROUP