Healthcare Provider Details

I. General information

NPI: 1710910161
Provider Name (Legal Business Name): ROBERT KNODELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 OSLER DR SUITE 210
TOWSON MD
21204-7673
US

IV. Provider business mailing address

7401 OSLER DR SUITE 210
TOWSON MD
21204-7673
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-0033
  • Fax: 410-296-0186
Mailing address:
  • Phone: 410-296-0033
  • Fax: 410-296-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD15523
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: