Provider Demographics
NPI:1457328494
Name:SEPERSKY, ROBERT ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLAN
Last Name:SEPERSKY
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 1:511 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1479
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA54763Medicare UPIN