Active NPI
Anthony Cerundolo, MS, ATC, LAT, CSCS
- Athletic Trainer
- Worcester, MA
National Provider Identifier
1346385606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 646
- Practice address
- 1 College St
Worcester, MA 01610-2322 - Phone
- (508) 793-2644
- Fax
- (508) 793-3974
- NPI assigned
- Feb 21, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 646 | MA | Primary |
Addresses
Primary practice location
1 College St
Worcester, MA 01610-2322
Mailing address
9 Longfellow Rd
Worcester, MA 01602-2715
Phone (508) 793-2644
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2255A2300X | Other | MA | ATHLETIC TRIANER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 646 | MA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346385606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 LONGFELLOW RD",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016022715",
"telephone_number": "508-793-2644",
"fax_number": "508-793-3974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 COLLEGE ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016102322",
"telephone_number": "508-793-2644",
"fax_number": "508-793-3974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERUNDOLO",
"first_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "MS, ATC, LAT, CSCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "646",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRIANER",
"identifier": "2255A2300X",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.