Healthcare Provider Details

I. General information

NPI: 1245315563
Provider Name (Legal Business Name): GREGORY A BAZYLEWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 SCHOOL STREET
MANCHESTER MA
01944
US

IV. Provider business mailing address

195 SCHOOL STREET
MANCHESTER MA
01944
US

V. Phone/Fax

Practice location:
  • Phone: 978-526-4311
  • Fax: 978-525-2342
Mailing address:
  • Phone: 978-526-4311
  • Fax: 978-525-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45749
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: