Provider Demographics
NPI:1407051402
Name:ROBERT A. SEPERSKY, MD,PC
Entity Type:Organization
Organization Name:ROBERT A. SEPERSKY, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEPERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-947-5983
Mailing Address - Street 1:511 W GROVE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1458
Mailing Address - Country:US
Mailing Address - Phone:508-947-5983
Mailing Address - Fax:508-947-5048
Practice Address - Street 1:511 W GROVE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1458
Practice Address - Country:US
Practice Address - Phone:508-947-5983
Practice Address - Fax:508-947-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA54763Medicare UPIN