Provider Demographics
NPI:1104390665
Name:ROBINSON, DIORSHAY M
Entity type:Individual
Prefix:
First Name:DIORSHAY
Middle Name:M
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1827
Mailing Address - Country:US
Mailing Address - Phone:410-371-4301
Mailing Address - Fax:410-630-7788
Practice Address - Street 1:1011 N AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1827
Practice Address - Country:US
Practice Address - Phone:410-371-4301
Practice Address - Fax:410-630-7788
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
30AL3767-A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility