Provider Demographics
NPI:1164839684
Name:TSOUMAS, MIRANDA L (PA-C)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:TSOUMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LEE
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:280 CHESTNUT STREET
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:2014-07-16
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5095363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical