Provider Demographics
NPI:1497923098
Name:SCAFATI, ROBERT JOHN (RPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:SCAFATI
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CROFT REGIS RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1205
Mailing Address - Country:US
Mailing Address - Phone:781-492-1463
Mailing Address - Fax:781-329-9062
Practice Address - Street 1:101 CROFT REGIS RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1205
Practice Address - Country:US
Practice Address - Phone:781-492-1463
Practice Address - Fax:781-329-9062
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3461171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65897OtherBLUE CROSS BLUE SHIELD