Provider Demographics
NPI:1750304895
Name:INTERRANTE, ALBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:L
Last Name:INTERRANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-0688
Mailing Address - Country:US
Mailing Address - Phone:781-762-8010
Mailing Address - Fax:781-762-7753
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 215
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-762-5595
Practice Address - Fax:781-762-9966
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA358542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2019264Medicaid
MA035854OtherTUFTS HEALTH PLAN
MAC05073OtherBLUE SHIELD
MA24004OtherHARVARD PILGRIM
MA2019264Medicaid
MAFX0304Medicare PIN