Provider Demographics
NPI:1245206432
Name:BATES, ANNETTE K (PA)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:K
Last Name:BATES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:819 WORCESTER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1056
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:413-543-7962
Practice Address - Street 1:819 WORCESTER ST STE 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1056
Practice Address - Country:US
Practice Address - Phone:413-543-6820
Practice Address - Fax:413-543-7962
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2045363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP261001Medicare PIN