Provider Demographics
NPI:1093705824
Name:KUEMMERLE, FREDERICK D (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:D
Last Name:KUEMMERLE
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 1:75 LINDALL ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2121
Mailing Address - Country:US
Mailing Address - Phone:978-646-7088
Mailing Address - Fax:978-777-1462
Practice Address - Street 1:75 LINDALL ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2121
Practice Address - Country:US
Practice Address - Phone:978-646-7088
Practice Address - Fax:978-777-1462
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34973207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2022478Medicaid
MAA54009Medicare UPIN
MAD03094Medicare ID - Type Unspecified