Provider Demographics
NPI:1306959937
Name:CARDIOVASCULAR ASSOCIATES OF WESTERN MASS PC
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF WESTERN MASS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTILAL
Authorized Official - Middle Name:N
Authorized Official - Last Name:KENIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-562-7558
Mailing Address - Street 1:65 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1855
Mailing Address - Country:US
Mailing Address - Phone:413-562-7558
Mailing Address - Fax:413-562-0907
Practice Address - Street 1:65 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1855
Practice Address - Country:US
Practice Address - Phone:413-562-7558
Practice Address - Fax:413-562-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47638207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9786872Medicaid
MACG4156OtherRAILROAD MEDICARE
MA667837OtherTUFTS HEALH PLAN
MAM17274OtherBC/BS OF MASSACHUSETTS
MAM20796Medicare ID - Type Unspecified
MAB74257Medicare UPIN