Basic Information
| Provider Information | |||||||||
| NPI: | 1952492241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRISLIN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 ROCKLAND RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198033607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514200 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 04/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | C20004345 | DE | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP3000X | C20004345 | DE | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1597817 | 05 | MD | MEDICAID | 005702275 | 05 | VA | MEDICAID | 7611180 | 05 | NC | MEDICAID | Q04345 | 05 | SC | MEDICAID | 05460382 | 05 | IA | MEDICAID | 6197809 | 05 | NJ | MEDICAID | 001391820 | 05 | PA | MEDICAID | 02291981 | 05 | NY | MEDICAID | 20002293 | 05 | MN | MEDICAID |