Provider Demographics
NPI:1457352395
Name:VISSING, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:VISSING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:515 FAIRMOUNT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8518
Mailing Address - Country:US
Mailing Address - Phone:410-321-1224
Mailing Address - Fax:410-584-1874
Practice Address - Street 1:515 FAIRMOUNT AVE STE 320
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-321-1224
Practice Address - Fax:410-321-1231
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD33897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
190088ZR0ZMedicare PIN
B69828Medicare UPIN