Provider Demographics
NPI:1568717908
Name:WINGFIELD, ROBERT JOSHUA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSHUA
Last Name:WINGFIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 32ND STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712
Mailing Address - Country:US
Mailing Address - Phone:301-922-7012
Mailing Address - Fax:
Practice Address - Street 1:4357 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2603
Practice Address - Country:US
Practice Address - Phone:301-922-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1001085103T00000X
MD05527103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1001085OtherDC DEPARTMENT OF HEALTH
MD05527OtherMARYLAND DEPARTMENT OF HEALTH
MD801004B00Medicaid