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General NPI Number Information
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NPI Number | 1407051402
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Entity Type | Organization
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Legal Business Name | ROBERT A. SEPERSKY, MD,PC
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 511 W GROVE ST SUITE 204
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City | MIDDLEBORO
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State | MA
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Zip | 02346-1458
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Country | US
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Telephone | 508-947-5983
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Fax | 508-947-5048
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Provider Business Mailing Address
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Address Line | 511 W GROVE ST SUITE 204
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City | MIDDLEBORO
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State | MA
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Zip | 02346-1458
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Country | US
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Telephone | 508-947-5983
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Fax | 508-947-5048
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT A SEPERSKY
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Credential | MD
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Telephone | 508-947-5983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 43108
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License Number State | MA
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