Provider Demographics
NPI:1396752051
Name:BARTLEY, MARY M (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:95 SARGENT ST
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9881
Practice Address - Country:US
Practice Address - Phone:413-323-7212
Practice Address - Fax:413-967-2524
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA213407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2104610Medicaid
H73178Medicare UPIN
H73178Medicare UPIN