Provider Demographics
NPI:1952403081
Name:WHITTREDGE, RENNA B (MD)
Entity Type:Individual
Prefix:DR
First Name:RENNA
Middle Name:B
Last Name:WHITTREDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2115
Mailing Address - Country:US
Mailing Address - Phone:413-582-6800
Mailing Address - Fax:
Practice Address - Street 1:60 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2115
Practice Address - Country:US
Practice Address - Phone:413-582-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA541602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3014754Medicaid
MAA58665Medicare UPIN