Provider Demographics
NPI:1972349090
Name:GERIATRIC PRIMARY CARE PC
Entity type:Organization
Organization Name:GERIATRIC PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAY
Authorized Official - Middle Name:
Authorized Official - Last Name:AWKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-881-4161
Mailing Address - Street 1:723 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2540
Mailing Address - Country:US
Mailing Address - Phone:413-374-0031
Mailing Address - Fax:413-384-2526
Practice Address - Street 1:723 MAIN ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2540
Practice Address - Country:US
Practice Address - Phone:413-374-0031
Practice Address - Fax:413-384-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty