Basic Information
Provider Information
NPI: 1255417044
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MATTHEISS
FirstName: ROBIN
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 64589
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212644589
CountryCode: US
TelephoneNumber: 4108190710
FaxNumber: 4108190712
Practice Location
Address1: 1838 GREENE TREE RD
Address2: SUITE 400
City: BALTIMORE
State: MD
PostalCode: 212086391
CountryCode: US
TelephoneNumber: 4106027782
FaxNumber: 4108190712
Other Information
ProviderEnumerationDate: 10/27/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XR062544MDY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home