Active NPI
Robert Marriott Medical Corp
- Surgery Physician
- Mount Airy, MD
National Provider Identifier
1003367566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- ROBERT MARRIOTT MEDICAL CORP
- Practice address
- 713 Midway Ave
Mount Airy, MD 21771-2833 - Phone
- (877) 878-3289
- Fax
- (877) 817-3227
- NPI assigned
- Oct 19, 2016
- Organization subpart
- Yes
- Parent organization
- ADVANTAGE WOUND CARE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert J Marriott, MD
- Title
- Ceo
- Phone
- (877) 878-3289
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
713 Midway Ave
Mount Airy, MD 21771-2833
Mailing address
222 N Pacific Coast Hwy Ste 2175
El Segundo, CA 90245-5639
Phone (877) 878-3289
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 551507600 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110916000010 | MD | Part B Supplier - Clinic/Group Practice | 2567531494 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Annapolis, MD; Sykesville, MD; Rockville, MD; Princess Anne, MD; Pikesville, MD; Denton, MD; Baltimore, MD; Adelphi, MD |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Advantage Wound Care
- Part of
- Advantage Wound Care
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Surgery Physician
- Lafayette, LA
- NPI 1093266553
-
- Surgery Physician
- Warrington, PA
- NPI 1467903914
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476835200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1541635200000",
"number": "1003367566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 N PACIFIC COAST HWY STE 2175",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902455639",
"telephone_number": "877-878-3289",
"fax_number": "877-817-3227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "713 MIDWAY AVE",
"city": "MOUNT AIRY",
"state": "MD",
"postal_code": "217712833",
"telephone_number": "877-878-3289",
"fax_number": "877-817-3227"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROBERT MARRIOTT MEDICAL CORP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ADVANTAGE WOUND CARE",
"enumeration_date": "2016-10-19",
"last_updated": "2018-11-08",
"status": "A",
"authorized_official_last_name": "MARRIOTT",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "877-878-3289",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "551507600",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Airy, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.