Provider Demographics
NPI:1215668207
Name:GOUDREAULT, DAVID THEODORE (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:THEODORE
Last Name:GOUDREAULT
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3455 MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1147
Mailing Address - Country:US
Mailing Address - Phone:413-733-9600
Mailing Address - Fax:413-732-6534
Practice Address - Street 1:3455 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1142
Practice Address - Country:US
Practice Address - Phone:413-733-9600
Practice Address - Fax:413-732-6534
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2024-09-12
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical