Provider Demographics
NPI:1265649115
Name:BOURGEOIS, SEBASTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:
Last Name:BOURGEOIS
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 1:908 ALLEN STREET
Mailing Address - Street 2:SPRINGFIELD ANESTHESIA SERVICE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2533
Mailing Address - Country:US
Mailing Address - Phone:413-796-7494
Mailing Address - Fax:413-796-7497
Practice Address - Street 1:908 ALLEN STREET
Practice Address - Street 2:SPRINGFIELD ANESTHESIA SERVICE
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-2533
Practice Address - Country:US
Practice Address - Phone:413-796-7494
Practice Address - Fax:413-796-7497
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA242564207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program