Provider Demographics
NPI:1912962051
Name:KOSSACK, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:KOSSACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5 NEPONSET ST FL STREET2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:508-535-1662
Practice Address - Street 1:378 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2673
Practice Address - Country:US
Practice Address - Phone:508-852-8571
Practice Address - Fax:508-535-1662
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157064208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5978731OtherAETNA US HEALTHCARE
J19477OtherBLUE SHIELD HMO BLUE
AA1175OtherHARVARD PILGRIM HEALTHCAR
042472266OtherONE HEALTH PLAN
MA3185290Medicaid
784155OtherMVP HEALTH CARE
J19477OtherBLUE CARE ELECT
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherPRIVATE HEALTHCARE SYSTEM
33366OtherCHILDRENS MEDICAL SECURIT
J19477OtherBLUE SHIELD INDEMNITY
042472266OtherTHREE RIVERS
3356112OtherCIGNA HEALTH PLAN
2039833OtherFIRST HEALTH
33721OtherFALLON COMMUNITY HEALTH
3185290OtherWELFARE
33366OtherHEALTHY START
J19477OtherBLUE SHIELD INDEMNITY
5978731OtherAETNA US HEALTHCARE
33366OtherHEALTHY START