Provider Demographics
NPI:1770562282
Name:RISEBERG, ROBYN L (MD)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:L
Last Name:RISEBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 ALBANY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2511
Mailing Address - Country:US
Mailing Address - Phone:617-934-6009
Mailing Address - Fax:617-934-7102
Practice Address - Street 1:527 ALBANY ST STE 200
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2511
Practice Address - Country:US
Practice Address - Phone:617-934-6009
Practice Address - Fax:617-934-7102
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223769208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA38461Medicare ID - Type Unspecified
MAI31725Medicare UPIN