Healthcare Provider Details

I. General information

NPI: 1770039174
Provider Name (Legal Business Name): REBECCA BAILEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA MAHONEY PA-C

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 09/29/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305A MAPLE STREET
EAST LONGMEADOW MA
01028
US

IV. Provider business mailing address

819 WORCESTER ST STE 1
SPRINGFIELD MA
01151-1056
US

V. Phone/Fax

Practice location:
  • Phone: 413-304-2501
  • Fax:
Mailing address:
  • Phone: 413-304-2501
  • Fax: 413-789-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA5803
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: