Provider Demographics
NPI:1619488210
Name:BAYON MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:BAYON MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
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:
Authorized Official - Phone:857-452-6356
Mailing Address - Street 1:1075 WESTFORD ST # 204
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2845
Mailing Address - Country:US
Mailing Address - Phone:978-455-7992
Mailing Address - Fax:978-221-6168
Practice Address - Street 1:1075 WESTFORD ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2845
Practice Address - Country:US
Practice Address - Phone:978-395-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110120791BMedicaid
MA110120791AMedicaid