Healthcare Provider Details

I. General information

NPI: 1255320966
Provider Name (Legal Business Name): ROBERT ERNST MIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOUNT AUBURN ST STE 505
CAMBRIDGE MA
02138-5600
US

IV. Provider business mailing address

20 GUEST ST STE 225
BRIGHTON MA
02135-2065
US

V. Phone/Fax

Practice location:
  • Phone: 617-491-6766
  • Fax: 617-491-2552
Mailing address:
  • Phone: 617-738-8642
  • Fax: 617-202-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number47653
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: