Provider Demographics
NPI:1821607243
Name:ACOSTA BARRETO, GERARDO (AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:
Last Name:ACOSTA BARRETO
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FLOOR
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 DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-794-8020
Practice Address - Fax:413-794-2165
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9192363LA2100X
MARN2361180363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care