Healthcare Provider Details

I. General information

NPI: 1649473836
Provider Name (Legal Business Name): ERIC STEVEN BUSBY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 COGGESHALL ST
NEW BEDFORD MA
02746-2443
US

IV. Provider business mailing address

30 EARLS CT
ROCHESTER MA
02770-2025
US

V. Phone/Fax

Practice location:
  • Phone: 508-990-1900
  • Fax: 508-990-1929
Mailing address:
  • Phone: 508-679-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1486
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: