Provider Demographics
NPI:1669660940
Name:DR ROBERT GUEDENET
Entity Type:Organization
Organization Name:DR ROBERT GUEDENET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEDENET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-432-2222
Mailing Address - Street 1:21 WYAND DR
Mailing Address - Street 2:
Mailing Address - City:KEEDYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21756-1201
Mailing Address - Country:US
Mailing Address - Phone:301-432-2222
Mailing Address - Fax:301-432-4686
Practice Address - Street 1:21 WYAND DR
Practice Address - Street 2:
Practice Address - City:KEEDYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21756-1201
Practice Address - Country:US
Practice Address - Phone:301-432-2222
Practice Address - Fax:301-432-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD743LMedicare PIN