1801826284 NPI number — ROBERT M GOLUB M.D.

Table of content: ROBERT M GOLUB M.D. (NPI 1801826284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801826284 NPI number — ROBERT M GOLUB M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLUB
Provider First Name:
ROBERT
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1801826284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 8500 - 6335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-6335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-807-8000
Provider Business Mailing Address Fax Number:
215-807-8235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3998 RED LION RD
Provider Second Line Business Practice Location Address:
SUITE 235
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-632-3630
Provider Business Practice Location Address Fax Number:
215-632-3544
Provider Enumeration Date:
07/03/2006

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: 208600000X , with the licence number:  MD043758L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01275740-07 . This is a "AMERICHOICE TORRESDALE DI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1764412 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3942609 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03770 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30004517 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 763798 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012757400002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01275740-06 . This is a "AMERICHOICE FRANKFORD DIV" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2014602 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2969387 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012757400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012757400006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012757400009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0639927000 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01275740-08 . This is a "AMERICHOICE BUCKS DIVISIO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7638798 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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