Provider Demographics
NPI:1285789743
Name:THILO, ROBERT GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLENN
Last Name:THILO
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 1:7215 SE 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2640
Mailing Address - Country:US
Mailing Address - Phone:206-462-5199
Mailing Address - Fax:866-334-9417
Practice Address - Street 1:7215 SE 32ND ST
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2640
Practice Address - Country:US
Practice Address - Phone:206-462-5199
Practice Address - Fax:866-334-9417
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025209 MD000213502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry