Provider Demographics
NPI:1902882368
Name:GARBER, ROBERT L JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:GARBER
Suffix:JR
Gender:M
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 870179
Mailing Address - Street 2:
Mailing Address - City:MILTON VILLAGE
Mailing Address - State:MA
Mailing Address - Zip Code:02187-0179
Mailing Address - Country:US
Mailing Address - Phone:617-433-1425
Mailing Address - Fax:617-696-7012
Practice Address - Street 1:88 WHARF ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3429
Practice Address - Country:US
Practice Address - Phone:617-433-1425
Practice Address - Fax:617-696-7012
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA380492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3012077Medicaid
MAM09963Medicare ID - Type Unspecified
MA3012077Medicaid