Provider Demographics
NPI:1194907212
Name:MOHAMMAD S BAJWA MD PC
Entity type:Organization
Organization Name:MOHAMMAD S BAJWA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:SALEEM
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-533-7772
Mailing Address - Street 1:10 HOSPITAL DRIVE
Mailing Address - Street 2:THIRD FLOOR STE 310
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6603
Mailing Address - Country:US
Mailing Address - Phone:413-533-7772
Mailing Address - Fax:413-534-1699
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6603
Practice Address - Country:US
Practice Address - Phone:413-533-7772
Practice Address - Fax:413-534-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACX1062Medicare UPIN
MAM13270Medicare PIN