Provider Demographics
NPI:1679548788
Name:ALCORN, ROBERT WATSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WATSON
Last Name:ALCORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23366 COMMERCE PARK
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5850
Mailing Address - Country:US
Mailing Address - Phone:216-534-0627
Mailing Address - Fax:216-292-8865
Practice Address - Street 1:23366 COMMERCE PARK
Practice Address - Street 2:SUITE 207
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5850
Practice Address - Country:US
Practice Address - Phone:216-534-0627
Practice Address - Fax:216-292-8865
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0339352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH245952Medicaid
0402032Medicare PIN
OHA14807Medicare UPIN