Basic Information
| Provider Information | |||||||||
| NPI: | 1750771986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONCI | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 TINKHAM RD. | ||||||||
| Address2: | HEALTH SERVICES | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137314997 | ||||||||
| FaxNumber: | 4137830675 | ||||||||
| Practice Location | |||||||||
| Address1: | 271 CAREW ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137489000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 09/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA5199 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.