=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154866234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYON MEDICAL GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2016
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 UNION ST # 402
-----------------------------------------------------
City | LYNN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01901-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-780-7755
-----------------------------------------------------
Fax | 781-598-0243
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 280 UNION ST STE 402
-----------------------------------------------------
City | LYNN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01901-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-780-7755
-----------------------------------------------------
Fax | 781-598-0243
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | VLADIMIR BATRIN
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 857-452-6356
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 222926
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------