MEDICARE: DR. KENNETH S AQUILINO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	220880	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00148998	OTHER	MA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000028928	OTHER	BOSTON MEDICAL CENTER-HNP
2	8515618	OTHER	CIGNA
3	34826	OTHER	HEALTH NEW ENGLAND
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	220880	OTHER	CONNECTICARE OF MA
7	969755	OTHER	NETWORK HEALTH
8	(AA) 14839	OTHER	HARVARD PILGRIM
9	J27640	OTHER	HMO BLUE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	J27640	OTHER	BLUECROSS/BLUESHEILD OF

General Provider Information

NPI Number	:	1770583668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH S AQUILINO MD

Provider Business Mailing Address
First Line	:	260 NEW LUDLOW RD
Second Line	:
City	:	CHICOPEE
State	:	MA
Zip	:	01020-4324
Country	:	US
Telephone Number	:	413-533-3470
Fax Number	:	413-533-6859

Provider Business Practice Location Address
First Line	:	2 HOSPITAL DR
Second Line	:	SUITE 101
City	:	HOLYOKE
State	:	MA
Zip	:	01040-6603
Country	:	US
Telephone Number	:	413-536-8924
Fax Number	:	413-532-9141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	01/18/2008

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Directions to “ DR. KENNETH S AQUILINO MD” Practice Location

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