Provider Demographics
NPI:1487783536
Name:PLYMOUTH BAY INTERNAL MEDICINE
Entity type:Organization
Organization Name:PLYMOUTH BAY INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-746-2696
Mailing Address - Street 1:45 RESNIK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4844
Mailing Address - Country:US
Mailing Address - Phone:508-746-2696
Mailing Address - Fax:
Practice Address - Street 1:45 RESNIK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4844
Practice Address - Country:US
Practice Address - Phone:508-746-2696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
401728OtherTUFTS
694202OtherHARVARD PILGRIM
MA3195104Medicaid
J21238OtherBLUE CROSS
J21238OtherBLUE CROSS
G93738Medicare UPIN