Provider Demographics
NPI:1891785168
Name:STASZEWSKI, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:STASZEWSKI
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 1:30 LANCASTER STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-722-4100
Mailing Address - Fax:617-227-1134
Practice Address - Street 1:30 LANCASTER STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-722-4100
Practice Address - Fax:617-227-1134
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55312207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ11307OtherBCBS MA
MA3079228Medicaid
MA055312OtherTUFTS HEALTH PLAN
E89418Medicare UPIN
MAJ11307Medicare ID - Type Unspecified