Provider Demographics
NPI:1619000114
Name:SUMNER, ROBERT CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:SUMNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:28 LORD RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4548
Mailing Address - Country:US
Mailing Address - Phone:508-485-7660
Mailing Address - Fax:508-481-4540
Practice Address - Street 1:28 LORD RD
Practice Address - Street 2:SUITE 255
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4548
Practice Address - Country:US
Practice Address - Phone:508-485-7660
Practice Address - Fax:508-481-4540
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA032745207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6173411Medicaid
04-3035909OtherMIMA GROUP TAX ID
MAC05036OtherBLUE CROSS BLUE SHIELD
MA2000000232OtherHARVARD PILGRIM HEALTH
MA600427OtherTUFTS HEALTH PLAN
B97148Medicare UPIN
MA6173411Medicaid