Provider Demographics
NPI:1669545539
Name:PENNEY, RANDY SCOTT (CPD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:SCOTT
Last Name:PENNEY
Suffix:
Gender:M
Credentials:CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 NORTH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW BENFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740
Mailing Address - Country:US
Mailing Address - Phone:508-993-3450
Mailing Address - Fax:508-993-3455
Practice Address - Street 1:543 NORTH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW BENFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-993-3450
Practice Address - Fax:508-993-3455
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA401154OtherBLUE CROSS BLUE SHIELD
MA1528866Medicaid
MA5386930001Medicare ID - Type Unspecified