Provider Demographics
NPI:1932140266
Name:BOOTH, ROBERT EMREY JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EMREY
Last Name:BOOTH
Suffix:JR
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 8500-1672
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106
Mailing Address - Country:US
Mailing Address - Phone:215-269-6700
Mailing Address - Fax:215-269-6701
Practice Address - Street 1:601 WALNUT ST
Practice Address - Street 2:STE L50
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3323
Practice Address - Country:US
Practice Address - Phone:215-409-9300
Practice Address - Fax:215-409-9365
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035352L207XS0114X
NJ25MA03361200207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2082745OtherAETNA
PA0052330000OtherI.B.C.
PA2082745OtherAETNA
PA049319Medicare ID - Type Unspecified