Provider Demographics
NPI:1588637102
Name:BAYUK, JONATHAN LEE (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LEE
Last Name:BAYUK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:269 LOCUST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01062-2003
Mailing Address - Country:US
Mailing Address - Phone:413-586-0769
Mailing Address - Fax:413-584-0392
Practice Address - Street 1:269 LOCUST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01062-2003
Practice Address - Country:US
Practice Address - Phone:413-586-0769
Practice Address - Fax:413-584-0392
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223052207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110040659/AMedicaid
MAP00470879OtherRR MEDICARE
MAP00470879OtherRR MEDICARE