Healthcare Provider Details

I. General information

NPI: 1265649115
Provider Name (Legal Business Name): SEBASTIAN BOURGEOIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 ALLEN STREET SPRINGFIELD ANESTHESIA SERVICE
SPRINGFIELD MA
01118-2533
US

IV. Provider business mailing address

908 ALLEN ST
SPRINGFIELD MA
01118-2569
US

V. Phone/Fax

Practice location:
  • Phone: 413-796-7494
  • Fax: 413-796-7497
Mailing address:
  • Phone: 413-796-7494
  • Fax: 413-796-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number242564
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number52255
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: