Healthcare Provider Details

I. General information

NPI: 1376579458
Provider Name (Legal Business Name): ROBERT CROSIER MCKERSIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PARK ST
LAWRENCE MA
01841-2517
US

IV. Provider business mailing address

150 PARK ST
LAWRENCE MA
01841-2517
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-1770
  • Fax: 978-686-4478
Mailing address:
  • Phone: 978-685-1770
  • Fax: 978-686-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number233843
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: