Provider Demographics
NPI:1336101435
Name:DESIMONE, ROBERT MICHAEL (LAT, ATC, EMT, RN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:DESIMONE
Suffix:
Gender:M
Credentials:LAT, ATC, EMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WEATHERVANE RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-5658
Mailing Address - Country:US
Mailing Address - Phone:781-696-3538
Mailing Address - Fax:
Practice Address - Street 1:8 WEATHERVANE RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-5658
Practice Address - Country:US
Practice Address - Phone:781-696-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA842787146N00000X
MA15012255A2300X
MA269340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered163W00000XNursing Service ProvidersRegistered Nurse