Provider Demographics
NPI:1407528789
Name:DEAVER, KYLE SAGE (PA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:SAGE
Last Name:DEAVER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:280 CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL CENTER DR STE 512
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1273
Practice Address - Country:US
Practice Address - Phone:413-794-5550
Practice Address - Fax:413-794-4212
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2022-05-06
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant