Provider Demographics
NPI:1235125402
Name:LISS, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:LISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:419 REDWOOD ST
Mailing Address - Street 2:420
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1734
Mailing Address - Country:US
Mailing Address - Phone:410-328-6533
Mailing Address - Fax:410-328-1178
Practice Address - Street 1:419 REDWOOD ST
Practice Address - Street 2:420
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-6533
Practice Address - Fax:410-328-1178
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0012572207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001871600Medicaid
MD5433Medicare ID - Type Unspecified
MDD76664Medicare UPIN
MD001871600Medicaid