Provider Demographics
NPI:1669767331
Name:PARTNERS MEDICAL GROUP LLC
Entity type:Organization
Organization Name:PARTNERS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBUSTIANO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:941-916-2168
Mailing Address - Street 1:200 GLENN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2573
Mailing Address - Country:US
Mailing Address - Phone:301-777-2696
Mailing Address - Fax:301-777-1049
Practice Address - Street 1:200 GLENN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2573
Practice Address - Country:US
Practice Address - Phone:301-777-2696
Practice Address - Fax:301-777-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD14865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002011700Medicaid
MD002011700Medicaid