Healthcare Provider Details

I. General information

NPI: 1194427096
Provider Name (Legal Business Name): MACKAY D. BURGON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST # S6538
SPRINGFIELD MA
01107-1619
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-3233
  • Fax: 413-794-9060
Mailing address:
  • Phone: 413-794-5700
  • Fax: 413-794-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1027992
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: