Healthcare Provider Details

I. General information

NPI: 1841470804
Provider Name (Legal Business Name): DOROTA JOANNA LEBIEDZ-ODROBINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 SOUTH ST
SOUTHBRIDGE MA
01550-4000
US

IV. Provider business mailing address

94 SOUTH ST
SOUTHBRIDGE MA
01550-4000
US

V. Phone/Fax

Practice location:
  • Phone: 508-764-2772
  • Fax: 508-764-2833
Mailing address:
  • Phone: 508-764-2772
  • Fax: 508-764-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number238986
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: