Provider Demographics
NPI:1821132234
Name:MEDIC, ROBIN E (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:MEDIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:130 HOSPITAL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4015
Mailing Address - Country:US
Mailing Address - Phone:410-535-1108
Mailing Address - Fax:410-535-4088
Practice Address - Street 1:130 HOSPITAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4015
Practice Address - Country:US
Practice Address - Phone:410-535-1108
Practice Address - Fax:410-535-4088
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0070953208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD038318000Medicaid
MD201820Medicare PIN