Basic Information
| Provider Information | |||||||||
| NPI: | 1770583668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AQUILINO | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 NEW LUDLOW RD | ||||||||
| Address2: | |||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010204324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135333470 | ||||||||
| FaxNumber: | 4135336859 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 HOSPITAL DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010406603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135368924 | ||||||||
| FaxNumber: | 4135329141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 220880 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000028928 | 01 | BOSTON MEDICAL CENTER-HNP | OTHER | 8515618 | 01 | CIGNA | OTHER | 34826 | 01 | HEALTH NEW ENGLAND | OTHER | P00148998 | 01 | MA | MEDICARE RAILROAD | OTHER | 2071207 | 01 | MA MEDICAID PCC | OTHER | 220880 | 01 | CONNECTICARE OF MA | OTHER | 969755 | 01 | NETWORK HEALTH | OTHER | (AA) 14839 | 01 | HARVARD PILGRIM | OTHER | J27640 | 01 | HMO BLUE | OTHER | 2071207 | 05 | MA | MEDICAID | J27640 | 01 | BLUECROSS/BLUESHEILD OF | OTHER |