Individual
MYNGOC HO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
175 CAREW ST STE 200, SPRINGFIELD, MA 01104-2391
(413) 734-8254
Mailing address
54 VAIL ST, SPRINGFIELD, MA 01118-2161
(413) 459-1957
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA7130
MA
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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