Provider Demographics
NPI:1427057025
Name:MICHELSON, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MICHELSON
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:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-663-9095
Mailing Address - Fax:215-663-9578
Practice Address - Street 1:445 SHADY LN
Practice Address - Street 2:2ND FL
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8749
Practice Address - Country:US
Practice Address - Phone:215-663-9095
Practice Address - Fax:215-663-9578
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-026331E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0061655000OtherKEYSTONE
PA1197025033OtherCIGNA
PA220025651OtherRAILROAD MEDICARE
PA1007243OtherKEYSTONE MERCY
PA2122744OtherAETNA
NJ8250103OtherMEDICAID
PA01086725-02OtherHMA
PA176270OtherBLUE SHIELD
PAB40723OtherHEALTH PARTNERS
PAP00721337OtherRAILROAD MEDICARE
PA3Y3737OtherHEALTH NET
PAMOS134OtherOXFORD
PA001086725-0002Medicaid
PA597586OtherMEDICARE GROUP
PA168385OtherOAKTREE
PA220025651OtherRAILROAD MEDICARE
PAMOS134OtherOXFORD
PA176270Medicare PIN