Provider Demographics
NPI:1487881371
Name:STAVERT, ROBERT RAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAUL
Last Name:STAVERT
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 1:140 SAINT BOTOLPH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5208
Mailing Address - Country:US
Mailing Address - Phone:203-984-0304
Mailing Address - Fax:
Practice Address - Street 1:272 MARLBOROUGH ST
Practice Address - Street 2:APARTMENT 1F
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1747
Practice Address - Country:US
Practice Address - Phone:203-984-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256647207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty