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NPI Code Detail

MEDICARE: JERZY P. SOBOTA MD

MEDICARE: JERZY P. SOBOTA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0101XAnatomic Pathology Physician80133MA
2207ZP0105XClinical Pathology/Laboratory Medicine Physician80133MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447240635
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERZY P. SOBOTA MD
Provider Business Mailing Address
First Line : PO BOX 415348
Second Line :
City : BOSTON
State : MA
Zip : 02241-5348
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 40 WRIGHT ST
Second Line : DEPARTMENT OF PATHOLOGY
City : PALMER
State : MA
Zip : 01069-1138
Country : US
Telephone Number : 413-283-7651
Fax Number : 413-284-5339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 11/04/2010

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Directions to “ JERZY P. SOBOTA MD” Practice Location

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