Healthcare Provider Details

I. General information

NPI: 1457328494
Provider Name (Legal Business Name): ROBERT ALLAN SEPERSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W GROVE ST SUITE 204
MIDDLEBORO MA
02346-1458
US

IV. Provider business mailing address

511 W GROVE ST
MIDDLEBORO MA
02346-1479
US

V. Phone/Fax

Practice location:
  • Phone: 508-947-5983
  • Fax: 508-947-5048
Mailing address:
  • Phone: 508-947-5983
  • Fax: 508-947-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number43108
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: