Basic Information
Provider Information | |||||||||
NPI: | 1326265786 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROBINETT | ||||||||
FirstName: | KATHRYN | ||||||||
MiddleName: | SARAH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WALD | ||||||||
OtherFirstName: | KATHRYN | ||||||||
OtherMiddleName: | SARAH | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 64442 | ||||||||
Address2: |   | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 212644442 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4103281512 | ||||||||
FaxNumber: | 4103280177 | ||||||||
Practice Location | |||||||||
Address1: | 22 S GREENE ST | ||||||||
Address2: |   | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 212011544 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4103281512 | ||||||||
FaxNumber: | 4103280177 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2007 | ||||||||
LastUpdateDate: | 07/09/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | D68167 | MD | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | 6267364 | 01 | MD | AETNA HMO | OTHER | 029197800 | 05 | MD |   | MEDICAID | S062-0439 | 01 | MD | CAREFIRST BC/BS REGIONAL | OTHER | 7632919 | 01 | MD | AETNA PPO | OTHER | 964141-02 & 03 | 01 | MD | CAREFIRST BC/BS | OTHER | KS04BW F551-0062 | 01 | MD | CAREFIRST | OTHER | KS04 | 01 | MD | MEDICARE GROUP PTAN | OTHER |