Provider Demographics
NPI:1285695361
Name:ROBERT LONIGRO, MD, PC
Entity type:Organization
Organization Name:ROBERT LONIGRO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LONIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-254-4923
Mailing Address - Street 1:45 PADDOCK WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-8242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 PADDOCK WAY
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-8242
Practice Address - Country:US
Practice Address - Phone:781-254-4923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76441207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9715126Medicare ID - Type UnspecifiedMEDICAID GROUP NUMBER
MAM15667Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER