Provider Demographics
NPI:1972601433
Name:ROBERT D. MATHIESON AND ASSOCIATES, M.D., LLC
Entity type:Organization
Organization Name:ROBERT D. MATHIESON AND ASSOCIATES, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATHIESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-243-4460
Mailing Address - Street 1:3333 N CALVERT ST
Mailing Address - Street 2:SUITE # 680
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2867
Mailing Address - Country:US
Mailing Address - Phone:410-243-4460
Mailing Address - Fax:
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:SUITE # 680
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-243-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21327207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD602700800Medicaid
MDCJ9282OtherRAILROAD MEDICARE GROUP #
MDLK90ROOtherCAREFIRST MARYLAND GRP #
MDW297OtherBLUECHOICE MARYLAND GRP #
MD748LMedicare PIN
MDW297OtherBLUECHOICE MARYLAND GRP #