Provider Demographics
NPI:1215045786
Name:SLOANE, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SLOANE
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 1:480 LYNNFIELD ST
Mailing Address - Street 2:EAST.MED.BLDG
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-1419
Mailing Address - Country:US
Mailing Address - Phone:781-581-3280
Mailing Address - Fax:781-581-7990
Practice Address - Street 1:480 LYNNFIELD ST
Practice Address - Street 2:EAST.MED.BLDG
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-1419
Practice Address - Country:US
Practice Address - Phone:781-581-3280
Practice Address - Fax:781-581-7990
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA30913208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2015684Medicaid
B73743Medicare UPIN
MA2015684Medicaid