Provider Demographics
NPI:1164412888
Name:DESMOND, ROBERT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:DESMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W. MAIN ST.
Mailing Address - Street 2:STE. 512
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2020
Mailing Address - Country:US
Mailing Address - Phone:215-362-2161
Mailing Address - Fax:215-362-2161
Practice Address - Street 1:100 W. MAIN ST.
Practice Address - Street 2:STE. 512
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2020
Practice Address - Country:US
Practice Address - Phone:215-362-2161
Practice Address - Fax:215-362-2161
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025634E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP006303OtherCHAMPUS
PAC30834Medicare UPIN
PA123353Medicare ID - Type Unspecified