Provider Demographics
NPI:1154384113
Name:LOUNSBURY, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:LOUNSBURY
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 1:1109 GRANBY RD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1568
Mailing Address - Country:US
Mailing Address - Phone:413-523-0810
Mailing Address - Fax:413-523-0930
Practice Address - Street 1:1109 GRANBY RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1568
Practice Address - Country:US
Practice Address - Phone:413-523-0810
Practice Address - Fax:413-523-0930
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6176941Medicaid
MAH01013Medicare ID - Type Unspecified
MAA66450Medicare UPIN