Provider Demographics
NPI:1215037973
Name:EWTON, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:EWTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1711
Mailing Address - Country:US
Mailing Address - Phone:781-235-9200
Mailing Address - Fax:781-235-9202
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:SUITE 109
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1711
Practice Address - Country:US
Practice Address - Phone:781-235-9200
Practice Address - Fax:781-235-9202
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB33387OtherBC/BS
MA698545OtherTUFTS HEALTH PLAN
MAA35562Medicare UPIN
MAB33387Medicare ID - Type Unspecified