Healthcare Provider Details

I. General information

NPI: 1619941853
Provider Name (Legal Business Name): ALLAN P. BAUSTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 RUSSELL ST #7
HADLEY MA
01035-3534
US

IV. Provider business mailing address

234 RUSSELL ST #7
HADLEY MA
01035-3534
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-6020
  • Fax: 413-584-0286
Mailing address:
  • Phone: 413-586-6020
  • Fax: 413-584-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59425
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: