Provider Demographics
NPI:1366435232
Name:MICHELINI, ROBERT GUIDO (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GUIDO
Last Name:MICHELINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:689 YORKTOWN RD
Practice Address - Street 2:
Practice Address - City:LEWISBERRY
Practice Address - State:PA
Practice Address - Zip Code:17339-9258
Practice Address - Country:US
Practice Address - Phone:717-932-4050
Practice Address - Fax:717-932-8072
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006157L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030434610002Medicaid
PA549486F6KMedicare PIN