Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 828 | MD |
Y | 103T00000X | Psychologist | 828 | MD |
NPI | 1992986145 |
---|---|
Provider Name | Philip Dean Robison |
First Address | Ellicott City, MD 21042-4035 |
Second Address | Ellicott City, MD 21042-4035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2007 |
Last Update Date | 15/11/2007 |