1356334775 NPI number — MR. ROBERT KEITH WOLFSKILL ATC, CSCS

Table of content: MR. ROBERT KEITH WOLFSKILL ATC, CSCS (NPI 1356334775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356334775 NPI number — MR. ROBERT KEITH WOLFSKILL ATC, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFSKILL
Provider First Name:
ROBERT
Provider Middle Name:
KEITH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC, CSCS
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:
1356334775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 STARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-8252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-695-0146
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 ROBERT GRANT AVE
Provider Second Line Business Practice Location Address:
BIOCHEMISTRY 2W130
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910-7500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-319-9462
Provider Business Practice Location Address Fax Number:
301-319-9150
Provider Enumeration Date:
08/31/2005

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: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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