Provider Demographics
NPI:1699177394
Name:CONOLLY, CAROL LYNN (RPA-C)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:CONOLLY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 CONWAY ST
Mailing Address - Street 2:VALLEY MEDICAL GROUP, PC-GREENFIELD HEALTH CENTER
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1521
Mailing Address - Country:US
Mailing Address - Phone:413-774-6301
Mailing Address - Fax:866-644-0871
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:VALLEY MEDICAL GROUP, PC-GREENFIELD HEALTH CENTER
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1521
Practice Address - Country:US
Practice Address - Phone:413-774-6301
Practice Address - Fax:866-644-0871
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5825363A00000X, 363A00000X
NY018036363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400361133Medicare PIN