Provider Demographics
NPI:1629010947
Name:HYNNINEN, BRETT C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:C
Last Name:HYNNINEN
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 1:271 PARK ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3311
Mailing Address - Country:US
Mailing Address - Phone:413-785-1153
Mailing Address - Fax:413-781-4951
Practice Address - Street 1:55 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2546
Practice Address - Country:US
Practice Address - Phone:413-774-7979
Practice Address - Fax:413-775-0222
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161095208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3199975Medicaid
MA25255OtherHNE
MA406529OtherTUFTS
MA80558OtherHARVARD PILGRIM
MAJ21646OtherBCBS
VT0001519OtherMEDICARE
MAA29827Medicare ID - Type Unspecified
MA3199975Medicaid