Healthcare Provider Details

I. General information

NPI: 1629024849
Provider Name (Legal Business Name): ROBERT T OWNBEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST MS 435
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

1601 CHERRY ST SUITE 11511
PHILADELPHIA PA
19102-1321
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-8873
  • Fax: 215-762-3274
Mailing address:
  • Phone: 215-255-7822
  • Fax: 215-255-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD074365L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: