Provider Demographics
NPI:1467475145
Name:ROBIN BISSELL, M.D, LLC
Entity Type:Organization
Organization Name:ROBIN BISSELL, M.D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-895-4270
Mailing Address - Street 1:124 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-0718
Mailing Address - Country:US
Mailing Address - Phone:301-895-4270
Mailing Address - Fax:301-895-4277
Practice Address - Street 1:124 MILLER ST
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-0718
Practice Address - Country:US
Practice Address - Phone:301-895-4270
Practice Address - Fax:301-895-4277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034231261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD287151300Medicaid
MDE53239Medicare UPIN