Provider Demographics
NPI:1487645008
Name:DONOFF, ROBERT BRUCE (DMD MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:DONOFF
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Gender:M
Credentials:DMD MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 230
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-8222
Practice Address - Fax:617-726-2814
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA37230204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA701748OtherTUFTS HEALTH PLAN
MA0154245Medicaid
MAM09409OtherBCBS MA
MA701748OtherTUFTS HEALTH PLAN
MAM09409Medicare ID - Type Unspecified