Healthcare Provider Details

I. General information

NPI: 1457546764
Provider Name (Legal Business Name): BONNIE H PADDLEFORD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN STREET 3RD FLOOR, SUITE A
SPRINGFIELD MA
01199-1619
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FLOOR
SPRINGFIELD MA
01199-1619
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7031
  • Fax: 413-794-7133
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2374
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: