Provider Demographics
NPI:1134145006
Name:ROBINSON, SHENANDOAH N (MD)
Entity Type:Individual
Prefix:
First Name:SHENANDOAH
Middle Name:N
Last Name:ROBINSON
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 64286
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:PHIPPS 101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076022207T00000X
MDD80855207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2126381Medicaid
OH2145965OtherAETNA
OH363958OtherWELLCARE MEDICAID
MI1134145006OtherMICHIGAN MEDICAID
OH2126381OtherBCMH
OH000000130227OtherANTHEM
OH000000221278OtherUNISON
OH000000523189OtherANTHEM
OH727615OtherBUCKEYE MEDICAID
PA0019505340001Medicaid
OHP00450169OtherRAILROAD MEDICARE
OH000000221278OtherUNISON
OH2126381Medicaid
OH363958OtherWELLCARE MEDICAID