Provider Demographics
NPI:1114071537
Name:FATHMAN, ROBERT E (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:FATHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 BRADENTON AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3511
Mailing Address - Country:US
Mailing Address - Phone:614-579-1699
Mailing Address - Fax:
Practice Address - Street 1:5060 BRADENTON AVE
Practice Address - Street 2:STE. A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3511
Practice Address - Country:US
Practice Address - Phone:614-579-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFACP00181Medicare ID - Type Unspecified
OHR71977Medicare UPIN