Healthcare Provider Details

I. General information

NPI: 1366542342
Provider Name (Legal Business Name): BAYSTATE OB/GYN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 MAIN ST STE C
SPRINGFIELD MA
01107-1187
US

IV. Provider business mailing address

354 BIRNIE AVE STE 202
SPRINGFIELD MA
01107-1109
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-8484
  • Fax: 413-794-8477
Mailing address:
  • Phone: 413-794-8484
  • Fax: 413-794-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALYSA MAJOR
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 413-794-2519