Provider Demographics
NPI:1366562159
Name:DREDGE, DAVID C (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:DREDGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:50 WASON AVE
Practice Address - Street 2:1ST FL
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1274
Practice Address - Country:US
Practice Address - Phone:413-794-0814
Practice Address - Fax:413-794-7145
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2388572084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082747AMedicaid
MA110082747AMedicaid