Provider Demographics
NPI:1710603741
Name:OVERSTREET, ROBERT LEE
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:OVERSTREET
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 1:14926 LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5581
Mailing Address - Country:US
Mailing Address - Phone:301-268-7409
Mailing Address - Fax:
Practice Address - Street 1:14926 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-5581
Practice Address - Country:US
Practice Address - Phone:301-268-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant