Individual ProviderEzra AcholonuPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address759 Chestnut St, Springfield, MA 01199-1001(413) 794-4320(800) 465-3203PECOS EnrollmentBased on the most recent information from CMS, provider Ezra Acholonu is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1407221302Provider TypeIndividualFull NameAcholonu, EzraTitleMr.CredentialPAGenderMaleSole ProprietorYesEnumeration Date12/3/2015Last Updated9/18/2020Contact InformationPractice LocationPractice Address759 Chestnut St, Springfield, MA 01199-1001Phone(413) 794-4320FaxUnlisted FaxMailing LocationMailing Address215 N Main St, White River Junction, VT 05009-0001Phone(800) 465-3203FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363AM0700XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA5539MassachusettsCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA5539Massachusetts