Provider Demographics
NPI:1588604656
Name:ROBINSON, SHAWN W (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:W
Last Name:ROBINSON
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-3648
Mailing Address - Fax:410-328-2062
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3648
Practice Address - Fax:410-328-2062
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46778207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2289134Medicaid
MD543793-01OtherBLUE CROSS/BLUE SHIELD
MD455001300Medicaid
VA5849900Medicaid
DE1588604656Medicaid
MT1588604656Medicaid
DE1588604656Medicaid
MDS083120OMedicare PIN
MT1588604656Medicaid