Provider Demographics
NPI:1740364298
Name:MENSCH, FRED E (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:E
Last Name:MENSCH
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 1:426 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8228
Mailing Address - Country:US
Mailing Address - Phone:413-496-9272
Mailing Address - Fax:413-442-6990
Practice Address - Street 1:426 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8228
Practice Address - Country:US
Practice Address - Phone:413-496-9272
Practice Address - Fax:413-442-6990
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47652207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0151785Medicaid
MAI22276OtherBLUE SHIELD
MA0151785Medicaid
MAI22276OtherBLUE SHIELD