Provider Demographics
NPI:1053467951
Name:PASTRANA, APOLINARIO C (MD)
Entity type:Individual
Prefix:
First Name:APOLINARIO
Middle Name:C
Last Name:PASTRANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1619
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:46 DAGGETT DR
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4638
Practice Address - Country:US
Practice Address - Phone:413-794-9110
Practice Address - Fax:413-794-9116
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12307207R00000X
MA246588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI530693-03Medicaid
HI00A0239895OtherHMSA BILLING NUMBER
HIH55745Medicare PIN
HI00A0239895OtherHMSA BILLING NUMBER