Provider Demographics
NPI:1619967270
Name:SCHOENTHALER, ROBIN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:SCHOENTHALER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:100 BLOSSOM ST
Practice Address - Street 2:COX 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2606
Practice Address - Country:US
Practice Address - Phone:978-287-3290
Practice Address - Fax:978-287-3295
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA764972085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3097285Medicaid
MAJ12715OtherBCBS MA
MA726282OtherTUFTS HEALTH PLAN
F16250Medicare UPIN
MA726282OtherTUFTS HEALTH PLAN