Provider Demographics
NPI:1518036961
Name:WROBLE, LORI (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:WROBLE
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 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5429
Practice Address - Fax:781-431-5548
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77238207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2015218Medicaid
MA0030469OtherNEIGHBORHOOD HEALTH PLAN
MA077238OtherTUFTS HEALTH PLAN
MA132412OtherHARVARD PILGRIM HEALTH CA
MA5456325OtherCIGNA HEALTH CARE
MANX2574Medicare PIN
MA0030469OtherNEIGHBORHOOD HEALTH PLAN