Provider Demographics
NPI:1932279007
Name:WINTER, ROBERT DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:WINTER
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 1:1 CENTURIAN DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2137
Mailing Address - Country:US
Mailing Address - Phone:302-999-0933
Mailing Address - Fax:302-999-8633
Practice Address - Street 1:1 CENTURIAN DR
Practice Address - Street 2:SUITE 105
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2137
Practice Address - Country:US
Practice Address - Phone:302-999-0933
Practice Address - Fax:302-999-8633
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000021901Medicaid
000181383OtherHIGHMARK BS
4288847OtherAETNA
0090301000OtherAMERIHEALTH
080149249OtherUNITED HC RAILROAD
DENEW587OtherBLUE CROSS SHIELD
50747OtherCOVENTRY
4288847OtherAETNA
0090301000OtherAMERIHEALTH