Provider Demographics
NPI:1922194380
Name:DEWBERRY, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:DEWBERRY
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 1:2411 W BELVEDERE AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5228
Mailing Address - Country:US
Mailing Address - Phone:410-601-8314
Mailing Address - Fax:410-601-9974
Practice Address - Street 1:2411 W BELVEDERE AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5228
Practice Address - Country:US
Practice Address - Phone:410-601-8314
Practice Address - Fax:410-601-9974
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF27379Medicare UPIN