Healthcare Provider Details

I. General information

NPI: 1558308205
Provider Name (Legal Business Name): NEIL D KOBROSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 WASHINGTON ST ADDISON GILBERT HOSPITAL
GLOUCESTER MA
01930
US

IV. Provider business mailing address

85 EASTERN AVE
GLOUCESTER MA
01930
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-4000
  • Fax: 978-282-0663
Mailing address:
  • Phone: 978-281-6890
  • Fax: 978-281-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number54501
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: