Provider Demographics
NPI:1164427407
Name:BRESLIN, ROBERT JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEFFREY
Last Name:BRESLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:STE 303
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2905
Mailing Address - Country:US
Mailing Address - Phone:410-435-4700
Mailing Address - Fax:410-323-0788
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:STE 303
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:410-435-4700
Practice Address - Fax:410-323-0788
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD369842086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE34613Medicare UPIN
MDH389X355Medicare ID - Type Unspecified