MEDICARE: ROBERT ALLAN SEPERSKY M.D.

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
1	174400000X	Specialist	43108	MA

General Provider Information

NPI Number	:	1457328494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ALLAN SEPERSKY M.D.

Provider Business Mailing Address
First Line	:	511 W GROVE ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1479
Country	:	US
Telephone Number	:	508-947-5983
Fax Number	:	508-947-5048

Provider Business Practice Location Address
First Line	:	511 W GROVE ST
Second Line	:	SUITE 204
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1458
Country	:	US
Telephone Number	:	508-947-5983
Fax Number	:	508-947-5048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/24/2007

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