Provider Demographics
NPI:1770583668
Name:AQUILINO, KENNETH S (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:AQUILINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:260 NEW LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4324
Mailing Address - Country:US
Mailing Address - Phone:413-533-3470
Mailing Address - Fax:413-533-6859
Practice Address - Street 1:2 HOSPITAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6603
Practice Address - Country:US
Practice Address - Phone:413-536-8924
Practice Address - Fax:413-532-9141
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA220880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000028928OtherBOSTON MEDICAL CENTER-HNP
8515618OtherCIGNA
34826OtherHEALTH NEW ENGLAND
MAP00148998OtherMEDICARE RAILROAD
2071207OtherMA MEDICAID PCC
220880OtherCONNECTICARE OF MA
969755OtherNETWORK HEALTH
(AA) 14839OtherHARVARD PILGRIM
J27640OtherHMO BLUE
MA2071207Medicaid
J27640OtherBLUECROSS/BLUESHEILD OF
J27640OtherHMO BLUE
220880OtherCONNECTICARE OF MA