Provider Demographics
NPI:1205889102
Name:BRECHT, JACQUELINE ELAINE (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELAINE
Last Name:BRECHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:40 CRANE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2335
Mailing Address - Country:US
Mailing Address - Phone:413-318-4670
Mailing Address - Fax:413-735-2012
Practice Address - Street 1:40 CRANE AVE
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2335
Practice Address - Country:US
Practice Address - Phone:413-318-4670
Practice Address - Fax:413-735-2012
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238159208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5275Medicaid
AKMD5275Medicaid
AKI05595Medicare UPIN