Provider Demographics
NPI:1891785572
Name:NILOFF, REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:NILOFF
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:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:10 HAWTHORNE PL
Practice Address - Street 2:STE 110
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2336
Practice Address - Country:US
Practice Address - Phone:617-724-0924
Practice Address - Fax:617-724-3413
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47311208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA709550OtherTUFTS HEALTH PLAN
MA6179029Medicaid
MAJ02828OtherBCBS MA
MA6179029Medicaid
MAJ02828Medicare ID - Type Unspecified