Provider Demographics
NPI:1285408138
Name:BAZOZA, PATRON NKURUNZIZA (MD)
Entity type:Individual
Prefix:MR
First Name:PATRON
Middle Name:NKURUNZIZA
Last Name:BAZOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:GEDEON
Other - Middle Name:NGABIRE
Other - Last Name:BAZOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:586 WESTBROOK ST UNIT 407
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1405
Mailing Address - Country:US
Mailing Address - Phone:325-518-5324
Mailing Address - Fax:
Practice Address - Street 1:586 WESTBROOK ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1400
Practice Address - Country:US
Practice Address - Phone:325-518-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty