Provider Demographics
NPI:1225260078
Name:BAFUMA, PATRICK JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JOHN
Last Name:BAFUMA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-443-7552
Practice Address - Fax:774-441-6086
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58388363A00000X
NMPA2021-0128363A00000X
MAPA8564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013460Medicaid
NY013460Medicare PIN
NY013460Medicare UPIN
NY013460Medicare Oscar/Certification