Provider Demographics
NPI:1487635587
Name:PROMISLOFF, ROBERT ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:PROMISLOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1001 CITY LINE AVE
Mailing Address - Street 2:WB 113
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3902
Mailing Address - Country:US
Mailing Address - Phone:610-896-0280
Mailing Address - Fax:610-896-0286
Practice Address - Street 1:1001 CITY LINE AVE
Practice Address - Street 2:WB 113
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3902
Practice Address - Country:US
Practice Address - Phone:610-896-0280
Practice Address - Fax:610-896-0286
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS003149L207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000707968Medicaid
PA000707968Medicaid
PA000707968Medicaid