Provider Demographics
NPI:1639675440
Name:PELL, ROBERT H
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:H
Last Name:PELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11607 ADMIRAL CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3508
Mailing Address - Country:US
Mailing Address - Phone:240-686-4509
Mailing Address - Fax:240-686-4509
Practice Address - Street 1:11607 ADMIRAL CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3508
Practice Address - Country:US
Practice Address - Phone:240-686-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL1137B310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility