Healthcare Provider Details

I. General information

NPI: 1033117221
Provider Name (Legal Business Name): ROBIN LEE BISSELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MILLER ST
GRANTSVILLE MD
21536-1383
US

IV. Provider business mailing address

PO BOX 718
GRANTSVILLE MD
21536-0718
US

V. Phone/Fax

Practice location:
  • Phone: 240-444-4219
  • Fax: 475-277-4961
Mailing address:
  • Phone: 240-444-4219
  • Fax: 475-277-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0034231
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: