Provider Demographics
NPI:1356304356
Name:DENTREMONT, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:DENTREMONT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 ALFRED ST
Mailing Address - Street 2:BALDWIN PARK II
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1976
Mailing Address - Country:US
Mailing Address - Phone:781-933-6236
Mailing Address - Fax:781-938-8050
Practice Address - Street 1:7 ALFRED ST
Practice Address - Street 2:BALDWIN PARK II
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1976
Practice Address - Country:US
Practice Address - Phone:781-933-6236
Practice Address - Fax:781-938-8050
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0091693001OtherCIGNA
MA20187OtherHARVARD COMMUNITY HEALTH
MAB54042OtherBLUE CROSS BLUE SHIELD
MA039357OtherTUFTS HEALTH PLAN
MA2049813Medicaid
MA0091693001OtherCIGNA