Provider Demographics
NPI:1821159484
Name:MARESH, ROBERT DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:MARESH
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 1:241 BLAKELEY CT
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7877
Mailing Address - Country:US
Mailing Address - Phone:504-920-8692
Mailing Address - Fax:352-300-3606
Practice Address - Street 1:241 BLAKELEY CT
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7877
Practice Address - Country:US
Practice Address - Phone:504-920-8692
Practice Address - Fax:352-300-3606
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1127622084P0800X
LA07935R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01455628OtherRAILROAD MEDICARE
FLP01455628OtherRAILROAD MEDICARE
FLHA130YMedicare PIN