Healthcare Provider Details

I. General information

NPI: 1033145271
Provider Name (Legal Business Name): ROBERT MICHAEL TAXIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 TILGHMAN ST
FOGELSVILLE PA
18051
US

IV. Provider business mailing address

PO BOX 1754
ALLENTOWN PA
18105-1754
US

V. Phone/Fax

Practice location:
  • Phone: 610-395-1936
  • Fax: 610-395-7263
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 003766L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: