Healthcare Provider Details

I. General information

NPI: 1467475145
Provider Name (Legal Business Name): ROBIN BISSELL, M.D, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MILLER ST
GRANTSVILLE MD
21536-0718
US

IV. Provider business mailing address

124 MILLER ST
GRANTSVILLE MD
21536-0718
US

V. Phone/Fax

Practice location:
  • Phone: 301-895-4270
  • Fax: 301-895-4277
Mailing address:
  • Phone: 301-895-4270
  • Fax: 301-895-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberD0034231
License Number StateMD

VIII. Authorized Official

Name: ROBIN L. BISSELL
Title or Position: OWNER
Credential: M.D.
Phone: 301-895-4270