Provider Demographics
NPI:1902846892
Name:STIPEK, ROBERT SYLVAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SYLVAN
Last Name:STIPEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:172 CAMBRIDGE STREET SUITE 204
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2984
Mailing Address - Country:US
Mailing Address - Phone:781-272-5484
Mailing Address - Fax:781-272-1616
Practice Address - Street 1:172 CAMBRIDGE STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2984
Practice Address - Country:US
Practice Address - Phone:781-272-5484
Practice Address - Fax:781-272-1616
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1455213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0328472Medicaid
MA110014349AMedicaid
MA0328472Medicaid