Provider Demographics
NPI:1508304163
Name:PAN, BONNIE
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 LYMAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-4145
Mailing Address - Country:US
Mailing Address - Phone:413-534-7354
Mailing Address - Fax:413-322-9288
Practice Address - Street 1:228 LYMAN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-4145
Practice Address - Country:US
Practice Address - Phone:413-534-7354
Practice Address - Fax:413-322-9288
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization