DR. GARY JOHN NIELAN NPI 1568458479

NPI Information

NPI: 1568458479
Provider Name: DR. GARY JOHN NIELAN
Classification: Pediatrics - 2080A0000X
Entity Type: Individual

Specialization: Adolescent Medicine

PECOS Registration: Yes

Address:
2207 BOSTON RD
WILBRAHAM, MA
ZIP 01095
Phone: (413) 599-1201
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DR. Gary John Nielan is an adolescent medicine pediatrics in Wilbraham, MA. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. DR. Gary John Nielan NPI is 1568458479. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2207 BOSTON RD
WILBRAHAM, MA
ZIP 01095-155
Phone: (413) 599-1201
Fax: (413) 596-2940

The NPI 1568458479 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/26/2005 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	155058	MASSACHUSETTS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2017078	OTHER		AETNA/USHC
2	155058	OTHER		MA LICENSE
3	23378	OTHER		HEALTH NEW ENGLAND
4	28036	OTHER		CHILDRENS MEDICAL SECURIT
5	353451	OTHER		HEALTHSOURCE MA NH
6	J18133	OTHER		BCBS
7	102170	OTHER		CIGNA
8	1550588404	OTHER		CONNECTICARE
9	3182916	MEDICAID	MASSACHUSETTS
10	1204585	OTHER		UNITED HEALTHCARE
11	155058	OTHER		TUFTS
12	975887	OTHER		NETWORK HEALTH
13	010155058MA01	OTHER		ANTHEM BCBS
14	201928	OTHER		HARVARD PILGRIM
15	000000008141	OTHER		BOSTON MED CENTER HEALTH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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