Healthcare Provider Details

I. General information

NPI: 1104147487
Provider Name (Legal Business Name): ROBYN D GARTRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBYN G HARRIS MD

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ORLEANS ST CRB I BUILDING, 3RD FLOOR, ROOM 307
BALTIMORE MD
21287
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
BALTIMORE MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-2548
  • Fax: 410-955-8897
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-07495
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number271105
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberD100474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: