Healthcare Provider Details

I. General information

NPI: 1174586176
Provider Name (Legal Business Name): EARTON C ROBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ALFRED ST BALDWIN PARK II
WOBURN MA
01801-1976
US

IV. Provider business mailing address

7 ALFRED ST BALDWIN PARK II
WOBURN MA
01801-1976
US

V. Phone/Fax

Practice location:
  • Phone: 781-933-6236
  • Fax: 781-938-8050
Mailing address:
  • Phone: 781-933-6236
  • Fax: 781-938-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31789
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier20190
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHARVARD COMMUNITY HEALTH
# 2
IdentifierB54028
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS BLUE SHIELD
# 3
Identifier2081652
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 4
Identifier0006454001
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA
# 5
Identifier031789
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH PLAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: