Provider Demographics
NPI:1245313410
Name:ACHINDIBA, ROBERT A
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:ACHINDIBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6352
Mailing Address - Country:US
Mailing Address - Phone:508-202-9683
Mailing Address - Fax:508-309-3686
Practice Address - Street 1:139 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6352
Practice Address - Country:US
Practice Address - Phone:508-202-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11061207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA242643OtherMASS LIC. #
RI007058132Medicare PIN
MA242643OtherMASS LIC. #