Provider Demographics
NPI:1033117221
Name:BISSELL, ROBIN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LEE
Last Name:BISSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-0718
Mailing Address - Country:US
Mailing Address - Phone:240-444-4219
Mailing Address - Fax:475-277-4961
Practice Address - Street 1:124 MILLER ST
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-1383
Practice Address - Country:US
Practice Address - Phone:240-444-4219
Practice Address - Fax:475-277-4961
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034231208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP13867OtherBCBS
MA287151300Medicaid
865494OtherUNITED HEALTH CARE
MDR1990001OtherBLUE CHOICE
MD287151300Medicaid
521686633OtherCOMMERCIAL
MD71816401OtherBS
521686633OtherCOMMERCIAL
MDR1990001OtherBLUE CHOICE
MDP13867OtherBCBS