Provider Demographics
NPI:1043239536
Name:SHAMBERGER, ROBERT COOPER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:COOPER
Last Name:SHAMBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVENUE
Mailing Address - Street 2:CHILDREN'S HOSPITAL BOSTON
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-8326
Mailing Address - Fax:617-730-0299
Practice Address - Street 1:300 LONGWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-8326
Practice Address - Fax:617-730-0299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42482208600000X, 2086S0102X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
A54900Medicare UPIN