Healthcare Provider Details

I. General information

NPI: 1902849714
Provider Name (Legal Business Name): ROBERT PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HSC T 11 ROOM 029
STONY BROOK NY
11794-8111
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-7720
  • Fax: 631-444-2785
Mailing address:
  • Phone: 631-444-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number186763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: