Provider Demographics
NPI:1083722862
Name:CHARD, BONNIE MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:MICHELLE
Last Name:CHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NORTH ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4111
Mailing Address - Country:US
Mailing Address - Phone:413-448-8291
Mailing Address - Fax:413-447-9040
Practice Address - Street 1:510 NORTH ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4111
Practice Address - Country:US
Practice Address - Phone:413-448-8291
Practice Address - Fax:413-447-9040
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP99963Medicare UPIN
MAAP2019Medicare ID - Type Unspecified