Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 52978 | MA |
NPI | 1043219397 |
---|---|
Provider Name | Debra A. Disandro |
First Address | Springfield, MA 01107-1088 |
Second Address | Springfield, MA 01107-1088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 07/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000006311 | BMC HEALTHNET (01) | MA |
0010789 | NEIGHBORHOOD HEALTH (01) | MA |
037323836 | TRICARE (01) | MA |
07-04622 | UNITED HEALTHCARE (01) | MA |
11833 | HEALTH NEW ENGLAND (01) | MA |
130705 | PILGRIM (01) | MA |
160039235 | RR MEDICARE (01) | MA |
3017699 | (05) | MA |
484978 | CONNECTICARE (01) | MA |
717957 | TUFTS (01) | MA |
782507 | US HEALTHCARE (01) | MA |
A58881 | (02) | MA |
DIJ06185 | BLUE SHIELD OF MASS (01) | MA |