Provider Demographics
NPI:1821037458
Name:O'TOOLE, ROBERT V (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:V
Last Name:O'TOOLE
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:PO BOX 64881
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4881
Mailing Address - Country:US
Mailing Address - Phone:410-448-6332
Mailing Address - Fax:410-448-6296
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-448-6332
Practice Address - Fax:410-448-6296
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61642207X00000X
MDD0061642207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1821037458OtherNPI
MDN822Medicare PIN
MDI35330Medicare UPIN
MDL791Medicare ID - Type UnspecifiedJHH #