Provider Demographics
NPI:1750470878
Name:PASSER, LUCILLE GOUGH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:GOUGH
Last Name:PASSER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FL
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 1:380 PLAINFIELD STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1524
Practice Address - Country:US
Practice Address - Phone:413-794-4458
Practice Address - Fax:413-794-5131
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA6167363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical