Provider Demographics
NPI:1780659656
Name:MAUSEL, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:MAUSEL
Suffix:
Gender:M
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:P.O. BOX 61137
Mailing Address - Street 2:
Mailing Address - City:LONG MEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01116-6137
Mailing Address - Country:US
Mailing Address - Phone:413-214-7435
Mailing Address - Fax:413-214-7436
Practice Address - Street 1:45 LOWER WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2747
Practice Address - Country:US
Practice Address - Phone:413-525-3958
Practice Address - Fax:413-525-3943
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33909207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN51561OtherB/S
MA0104949Medicaid
MA0104949Medicaid
MAN51561OtherB/S