Provider Demographics
NPI:1467991588
Name:SCHIBUK, LARRY
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:SCHIBUK
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:SCHIBUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FRCP(C)
Mailing Address - Street 1:90 FAWCETT ST UNIT 240
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1186
Mailing Address - Country:US
Mailing Address - Phone:857-317-9113
Mailing Address - Fax:
Practice Address - Street 1:157 UNION ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-486-5000
Practice Address - Fax:508-486-5480
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-103192084P0800X
MA2768012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry