Healthcare Provider Details

I. General information

NPI: 1861576456
Provider Name (Legal Business Name): GERRY G. BALOYO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 MAIN ST STE 201
SPRINGFIELD MA
01107-1150
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1000
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-0900
  • Fax: 413-794-2996
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1442
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: