Provider Demographics
NPI:1801826284
Name:GOLUB, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:GOLUB
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:P. O. BOX 8500 - 6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 235
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-632-3630
Practice Address - Fax:215-632-3544
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043758L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01275740-07OtherAMERICHOICE TORRESDALE DI
PA1764412OtherFIRST HEALTH
PA3942609OtherCIGNA
PA03770OtherHEALTH PARTNERS
PA30004517OtherKEYSTONE MERCY
PA763798OtherHIGHMARK BLUE SHIELD
PA0012757400002Medicaid
PA01275740-06OtherAMERICHOICE FRANKFORD DIV
PA2014602OtherUNITED HEALTHCARE
PA2969387OtherAETNA HMO
PA0012757400001Medicaid
PA0012757400006Medicaid
PA0012757400009Medicaid
PA0639927000OtherKEYSTONE IBC
PA01275740-08OtherAMERICHOICE BUCKS DIVISIO
PA7638798OtherPERSONAL CHOICE
PA0012757400006Medicaid
PA0012757400002Medicaid