Provider Demographics
NPI:1528024452
Name:GISE, ROBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:GISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:210 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2529
Mailing Address - Country:US
Mailing Address - Phone:508-755-4922
Mailing Address - Fax:508-756-9918
Practice Address - Street 1:210 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2529
Practice Address - Country:US
Practice Address - Phone:508-755-4922
Practice Address - Fax:508-756-9918
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2067269Medicaid
0800341OtherUNITED HEALTH CARE
15527OtherHARVARD PILGRIM HEALTH CA
988733OtherNETWORK HEALTH PLAN
039600OtherTUFTS HEALTH PLAN
0880401OtherEVERCARE UHC
MA4255OtherFALLON HEALTH PLAN
MAN01801OtherBS
4207OtherUS HEALTH CARE
0004670OtherNEIGHBORHOOD HEALTH PLAN
4274763OtherAETNA
0004670OtherNEIGHBORHOOD HEALTH PLAN
MA2067269Medicaid
MA4255OtherFALLON HEALTH PLAN