Provider Demographics
NPI:1609804632
Name:WILSTERMAN, ROBERT B (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:WILSTERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5 BRAMBLEBUSH PARK
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2325
Mailing Address - Country:US
Mailing Address - Phone:508-548-9423
Mailing Address - Fax:508-548-5239
Practice Address - Street 1:5 BRAMBLEBUSH PARK
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2325
Practice Address - Country:US
Practice Address - Phone:508-548-9423
Practice Address - Fax:508-548-5239
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80345207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA103249400OtherOWCP
MAJ14844OtherBLUE SHIELD NO
171098OtherHARVARD PILGRIM
200037348OtherRR MEDICARE
080345OtherTUFTS HEALTH PLAN
043464579OtherSTANDARD TAX ID NO
000000029156OtherBMC HEALTHNET
0900520OtherUNITED HEALTHCARE
MA3131581Medicaid
B20808901OtherCIGNA
200037348OtherRR MEDICARE
MA3131581Medicaid