Provider Demographics
NPI:1164417499
Name:PASCHALL, ROBERT MARK (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:PASCHALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 WOODBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-8501
Mailing Address - Country:US
Mailing Address - Phone:410-912-6114
Mailing Address - Fax:410-912-6115
Practice Address - Street 1:1630 WOODBROOKE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-8501
Practice Address - Country:US
Practice Address - Phone:410-912-6114
Practice Address - Fax:410-912-6115
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01020361082084N0400X
MDH897472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B61996Medicare UPIN
VAP00882903Medicare PIN
VA1164417499Medicaid
VAVAA103105Medicare PIN