Provider Demographics
NPI:1700860343
Name:BAHGAT, CHRISTINA ALVES (PA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ALVES
Last Name:BAHGAT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASON AVE
Mailing Address - Street 2:SUITE #360
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1381
Mailing Address - Country:US
Mailing Address - Phone:413-731-7877
Mailing Address - Fax:413-731-7870
Practice Address - Street 1:734 LONGMEADOW ST STE 201
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2245
Practice Address - Country:US
Practice Address - Phone:413-731-7877
Practice Address - Fax:413-731-7870
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P64076Medicare UPIN
MAAP1750Medicare ID - Type Unspecified