Robert Michael Medwid Jr., DMD

Key facts

NPI

1184844151

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

DS022446L (PA)

Practice address

1101 5TH Ave
Coraopolis, PA 15108

Phone

(412) 262-4555

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184844151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 5TH AVE",
            "city": "CORAOPOLIS",
            "state": "PA",
            "postal_code": "15108",
            "telephone_number": "412-262-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 5TH AVE",
            "city": "CORAOPOLIS",
            "state": "PA",
            "postal_code": "15108",
            "telephone_number": "412-262-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDWID",
        "first_name": "ROBERT",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS022446L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Coraopolis, PA · General Practice Dentistry in Pennsylvania