Provider Demographics
NPI:1265762280
Name:ROBERT C. HSIEH, M.D.,P.A.
Entity type:Organization
Organization Name:ROBERT C. HSIEH, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOICOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-699-1166
Mailing Address - Street 1:6510 KENILWORTH AVE
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1339
Mailing Address - Country:US
Mailing Address - Phone:301-699-1166
Mailing Address - Fax:301-209-9456
Practice Address - Street 1:6510 KENILWORTH AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1339
Practice Address - Country:US
Practice Address - Phone:301-699-1166
Practice Address - Fax:301-209-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD252351500Medicaid
MD252351500Medicaid