Provider Demographics
NPI:1326066432
Name:OSTROVSKY, MARVIN CARL (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:CARL
Last Name:OSTROVSKY
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 1:24 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1215
Mailing Address - Country:US
Mailing Address - Phone:508-460-3100
Mailing Address - Fax:508-460-3180
Practice Address - Street 1:24 NEWTON ST
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1215
Practice Address - Country:US
Practice Address - Phone:508-460-3100
Practice Address - Fax:508-460-3180
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2030438Medicaid
MA2030438Medicaid
E45006Medicare PIN
MAE245006Medicare ID - Type Unspecified