Healthcare Provider Details

I. General information

NPI: 1114105020
Provider Name (Legal Business Name): ROBERT D. MEHLMAN, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NETHERLANDS RD
BROOKLINE MA
02445-5442
US

IV. Provider business mailing address

20 NETHERLANDS RD
BROOKLINE MA
02445-5442
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-0073
  • Fax: 617-739-6295
Mailing address:
  • Phone: 617-232-0073
  • Fax: 617-739-6295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number24818
License Number StateMA

VIII. Authorized Official

Name: DR. ROBERT DAVID MEHLMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 617-232-0073