1508943291 NPI number — DONA H ROBERTSON CNM

Table of content: DONA H ROBERTSON CNM (NPI 1508943291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508943291 NPI number — DONA H ROBERTSON CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON
Provider First Name:
DONA
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
DONA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508943291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVRE DE GRACE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-939-3121
Provider Business Mailing Address Fax Number:
410-939-8278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 UPPER CHESAPEAKE DR
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-4339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-643-4300
Provider Business Practice Location Address Fax Number:
443-643-4303
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  R139296 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89286401 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 315096 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411678000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 612176400 . This is a "FEDERAL WORKMANS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1441858 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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