1477669497 NPI number — ROBINSON & MAX DERMATOLOGY P.A.

Table of content: (NPI 1477669497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477669497 NPI number — ROBINSON & MAX DERMATOLOGY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBINSON & MAX DERMATOLOGY P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477669497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 W RIDGELY RD
Provider Second Line Business Mailing Address:
SUITE 4B
Provider Business Mailing Address City Name:
LUTHERVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-5101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-561-1960
Provider Business Mailing Address Fax Number:
410-560-3497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W RIDGELY RD
Provider Second Line Business Practice Location Address:
SUITE 4B
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-5101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-561-1960
Provider Business Practice Location Address Fax Number:
410-560-3497
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
NEIL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-561-1960

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  D0026939 , 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: CI7619 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KE39RO . This is a "BLUE CROSS BLUE SHIELD MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R270 . This is a "BLUESHIELD DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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