Provider Demographics
NPI:1083689723
Name:PROBERT, DAVID L (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:PROBERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1065
Mailing Address - Country:US
Mailing Address - Phone:508-477-8373
Mailing Address - Fax:
Practice Address - Street 1:1 BLACKBURN DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2237
Practice Address - Country:US
Practice Address - Phone:978-281-1500
Practice Address - Fax:978-282-3699
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS44373Medicare UPIN
MAAP0393Medicare PIN