Provider Demographics
NPI:1043200983
Name:BOBRUFF, MARTHA ROTSTEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ROTSTEIN
Last Name:BOBRUFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-2400
Mailing Address - Country:US
Mailing Address - Phone:617-965-1299
Mailing Address - Fax:617-965-5799
Practice Address - Street 1:1261 FURNACE BROOK PKWY
Practice Address - Street 2:SUITE 20
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4721
Practice Address - Country:US
Practice Address - Phone:617-965-1299
Practice Address - Fax:617-965-5799
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA378102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3134121Medicaid
MAA35689Medicare UPIN
MAB33482Medicare ID - Type Unspecified