Provider Demographics
NPI:1447396700
Name:ROBIN, MICHAEL A (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:ROBIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10176 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:410-461-7012
Mailing Address - Fax:410-461-7009
Practice Address - Street 1:10176 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE 113
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:410-461-7012
Practice Address - Fax:410-461-7009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 0893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
111333OtherEYEMED
755OtherBALTIMORE CITY VISION CAR
209QOtherMEDICARE
111333OtherEYEMED