Provider Demographics
NPI:1154471191
Name:BOMBARDIER, GARRY M (MD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:M
Last Name:BOMBARDIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1785
Mailing Address - Country:US
Mailing Address - Phone:413-534-2500
Mailing Address - Fax:
Practice Address - Street 1:HOLYOKE HOSPITAL
Practice Address - Street 2:575 BEECH STREET
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-534-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine