Provider Demographics
NPI:1750373866
Name:WISCH, ROBIN I (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:I
Last Name:WISCH
Suffix:
Gender:F
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 8743
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8743
Mailing Address - Country:US
Mailing Address - Phone:410-360-4446
Mailing Address - Fax:410-360-4449
Practice Address - Street 1:3100 MOUNTAIN RD
Practice Address - Street 2:SUITE E
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2018
Practice Address - Country:US
Practice Address - Phone:410-360-4446
Practice Address - Fax:410-439-3541
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061968208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129389OtherMAMSI
406069500OtherAMERIGROUP
64298901OtherBCBS
0004OtherBCBS
796253OtherAETNA PPO
3657175OtherAETNA HMO
MD406069500Medicaid