Provider Demographics
NPI:1245654326
Name:GONZALEZ-BLOSSER, ALAN J (PA)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:GONZALEZ-BLOSSER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:J
Other - Last Name:BLOSSER
Other - Suffix:
Other - Last Name Type:Former Name
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 1:2344 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1104
Practice Address - Country:US
Practice Address - Phone:413-596-5550
Practice Address - Fax:413-794-2551
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4928363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400137595Medicare PIN