Provider Demographics
NPI:1962488296
Name:PLATENBERG, ROBERT CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CRAIG
Last Name:PLATENBERG
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 1:6904 BENJAMIN ST
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-1504
Mailing Address - Country:US
Mailing Address - Phone:703-300-0157
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC196752085N0700X
MDD00434052085N0700X
DEC100055942085N0700X
OH35073983P2085N0700X
PAMD063975L2085N0700X
TXK62422085N0700X
VA01010519602085N0700X
CO426672085N0700X
FLME941562085N0700X
HIMD120672085N0700X
IA322932085N0700X
MOMD1147532085N0700X
NM2001-2812085N0700X
NY52060882085N0700X
NVSP0902085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16851680004Medicaid
MI104520395Medicaid
TX47856202Medicaid
VA10093996Medicaid
WV2005354000Medicaid
MD756600001Medicaid
MD193M232FMedicare PIN
PA16851680004Medicaid
OH847791Medicare PIN
WV2005354000Medicaid
DC018294M65Medicare PIN
F50809Medicare UPIN
MI104520395Medicaid
TX47856202Medicaid
OH847792Medicare PIN
VA10093996Medicaid
PA037839N7WMedicare PIN