Provider Demographics
NPI:1891803052
Name:ATTLEBORO GASTROENTEROLOGY, PC
Entity Type:Organization
Organization Name:ATTLEBORO GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ROBBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-222-2021
Mailing Address - Street 1:150 EMORY ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2439
Mailing Address - Country:US
Mailing Address - Phone:508-222-2021
Mailing Address - Fax:508-226-0134
Practice Address - Street 1:150 EMORY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2439
Practice Address - Country:US
Practice Address - Phone:508-222-2021
Practice Address - Fax:508-226-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9778446Medicaid
MAM15160Medicare ID - Type UnspecifiedATTLEBORO GASTROENTEROLOG
MAE96991Medicare UPIN
MA9778446Medicaid
MAP40932Medicare UPIN
MAF37460Medicare UPIN