NPI 1407221302 · live from the CMS NPI Registry
Ezra Acholonu, PA
Physician Assistant, Medical in Springfield, MA. National Provider Identifier 1407221302, active.
NPI record
| NPI | 1407221302 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Medical 363AM0700X |
| Practice location | 759 Chestnut St, Springfield, MA 01199 |
| Practice phone | 413-794-4320 |
| Mailing address | 215 N Main St, White River Junction, VT 05009 |
| Enumerated | December 3, 2015 |
| Last updated | September 18, 2020 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | PA5539 (MA) |
| Physician Assistant, Medical primary | 363AM0700X | PA5539 (MA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.