Provider Demographics
NPI:1518048131
Name:MASTER, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MASTER
Suffix:
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 1:9A FOREST ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1501
Mailing Address - Country:US
Mailing Address - Phone:617-680-6892
Mailing Address - Fax:857-678-4049
Practice Address - Street 1:9A FOREST ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1501
Practice Address - Country:US
Practice Address - Phone:617-680-6892
Practice Address - Fax:857-678-4049
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA66923UHOtherHPHC NUMBER
MAM08434OtherBCBS NUMBER
MA0138401Medicaid
MAM08434OtherBCBS NUMBER
MA66923UHOtherHPHC NUMBER