Provider Demographics
NPI:1215126479
Name:PENNINGS, FREDERIK A (MD, PHD)
Entity type:Individual
Prefix:
First Name:FREDERIK
Middle Name:A
Last Name:PENNINGS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CAREW ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2478
Mailing Address - Country:US
Mailing Address - Phone:413-452-6650
Mailing Address - Fax:413-452-6675
Practice Address - Street 1:119 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2903
Practice Address - Country:US
Practice Address - Phone:508-334-1886
Practice Address - Fax:508-334-9769
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA234128207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2148056Medicaid
MA110078576AMedicaid
MA000450601Medicare PIN