Provider Demographics
NPI:1508046590
Name:ROBERT F. BLYTHE, MD
Entity Type:Organization
Organization Name:ROBERT F. BLYTHE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:OBENSCHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-575-5535
Mailing Address - Street 1:11161 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2606
Mailing Address - Country:US
Mailing Address - Phone:301-592-1225
Mailing Address - Fax:301-592-1229
Practice Address - Street 1:11161 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2606
Practice Address - Country:US
Practice Address - Phone:301-592-1225
Practice Address - Fax:301-592-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017548174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC341738090OtherRAILROAD MEDICARE
DC574085Medicare PIN
DC341738090Medicare Oscar/Certification
MDB93988Medicare UPIN