Healthcare Provider Details

I. General information

NPI: 1982016366
Provider Name (Legal Business Name): BRIAN JOSEPH BINNALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST S4604
SPRINGFIELD MA
01199-1619
US

IV. Provider business mailing address

280 CHESTNUT ST SECOND FLOOR
SPRINGFIELD MA
01199-1619
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-5550
  • Fax:
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5059
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: