Provider Demographics
NPI:1528092285
Name:CENNERAZZO, ALBERT J (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:J
Last Name:CENNERAZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3640 MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-739-0669
Mailing Address - Fax:413-739-0621
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-739-0669
Practice Address - Fax:413-739-0621
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA81743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine