=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326001215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT LAWRENCE SCHLOSSMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2006
-----------------------------------------------------
Last Update Date | 01/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 BROOKLINE AVE M229
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02215-5418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 613-632-5126
-----------------------------------------------------
Fax | 617-632-6624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 LANSING RD
-----------------------------------------------------
City | WEST NEWTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-632-5126
-----------------------------------------------------
Fax | 617-632-6624
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 75562
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------