Provider Demographics
NPI:1942290127
Name:MAYERNIK, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:MAYERNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7185 STILLWATER CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2988
Mailing Address - Country:US
Mailing Address - Phone:301-662-2300
Mailing Address - Fax:301-662-7364
Practice Address - Street 1:174 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4423
Practice Address - Country:US
Practice Address - Phone:301-662-2300
Practice Address - Fax:301-662-7364
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026401207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN71LMedicare ID - Type UnspecifiedGROUP
MDB70043Medicare UPIN
MD567EMedicare ID - Type UnspecifiedINDIVIDUAL