Basic Information
| Provider Information | |||||||||
| NPI: | 1629052121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVARD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5254 BAMBURG CT | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217032826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016631509 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1425 PORTER ST | ||||||||
| Address2: | USMARIID - MED DIVISION | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217029211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016194646 | ||||||||
| FaxNumber: | 2109162121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 08/27/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | MD-11854 | HI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.