Provider Demographics
NPI:1669545539
Name:PENNEY, RANDY SCOTT (CPD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:SCOTT
Last Name:PENNEY
Suffix:
Gender:M
Credentials:CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 NORTH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW BENFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740
Mailing Address - Country:US
Mailing Address - Phone:508-993-3450
Mailing Address - Fax:508-993-3455
Practice Address - Street 1:543 NORTH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW BENFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-993-3450
Practice Address - Fax:508-993-3455
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA401154OtherBLUE CROSS BLUE SHIELD
MA1528866Medicaid
MA5386930001Medicare ID - Type Unspecified