Provider Demographics
NPI:1740769728
Name:BAYON MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:BAYON MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BATRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:857-452-6356
Mailing Address - Street 1:280 UNION ST STE 402
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1353
Mailing Address - Country:US
Mailing Address - Phone:857-452-6356
Mailing Address - Fax:888-390-9437
Practice Address - Street 1:280 UNION ST STE 402
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1353
Practice Address - Country:US
Practice Address - Phone:857-452-6356
Practice Address - Fax:888-390-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5297101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110120791BMedicaid
MA110120791AMedicaid