Provider Demographics
NPI:1871799866
Name:FRED MENSCH MD, PC
Entity type:Organization
Organization Name:FRED MENSCH MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGINTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-499-1526
Mailing Address - Street 1:510 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4111
Mailing Address - Country:US
Mailing Address - Phone:413-499-1526
Mailing Address - Fax:413-448-2704
Practice Address - Street 1:510 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4111
Practice Address - Country:US
Practice Address - Phone:413-499-1526
Practice Address - Fax:413-448-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM14588OtherBLUE SHIELD
MA9769366Medicaid
MAM14588Medicare ID - Type Unspecified