Provider Demographics
NPI:1255322574
Name:MAGGIN, ROBERT YALE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:YALE
Last Name:MAGGIN
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 1:13952 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5000
Mailing Address - Country:US
Mailing Address - Phone:301-490-1990
Mailing Address - Fax:301-490-8750
Practice Address - Street 1:13952 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5000
Practice Address - Country:US
Practice Address - Phone:301-490-1990
Practice Address - Fax:301-490-8750
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD153691500Medicaid
046528R64Medicare ID - Type Unspecified
MD153691500Medicaid