Provider Demographics
NPI:1417919184
Name:MILGROME, TOBY M (MD)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:M
Last Name:MILGROME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:978-534-6500
Mailing Address - Fax:978-534-2991
Practice Address - Street 1:165 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-534-6500
Practice Address - Fax:978-534-2991
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherONE HEALTH PLAN
784163OtherMVP HEALTH CARE
91201OtherFALLON COMMUNITY HEALTH
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTRICARE CHAMPUS
2087570OtherMEDICAID WELFARE
5015435OtherCIGNA HEALTH PLAN
83258OtherCHILDRENS MED SECURITY
J28304OtherBLUE SHIELD HMO BLUE
MA2087570Medicaid
5550803OtherFIRST HEALTH
5624765OtherAETNA US HEALTHCARE
419293OtherTUFTS HEALTH PLAN
AA19860OtherHARVARD PILGRIM
042472266OtherTHREE RIVERS
J28304OtherBLUE CARE ELECT
J28304OtherBLUE SHIELD INDEMNITY
A37777OtherMEDICARE B
J28304OtherBLUE CARE ELECT
MA2087570Medicaid