Provider Demographics
NPI:1053425637
Name:MCKINLEY, ROBERT A (MD, FCCP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 MATTHEW ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1644
Practice Address - Country:US
Practice Address - Phone:740-568-5662
Practice Address - Fax:740-568-5672
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05394400207RP1001X
OH35.120455207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1752600Medicaid
OH0076874Medicaid
NJ223019073-003OtherST BARNABAS HEALTH PLAN
NJ110108123OtherMEDICARE RAILROAD
NJ5293060OtherAETNA
NJ223019073OtherTAX IDENTIFICATION NUMBER
NJMS383OtherOXFORD
NJ1752600Medicaid
OHP01208919OtherRAILROAD MEDICARE
NJ506686OtherAETNA
OH0076874Medicaid
NY04G17OtherEMPIRE BCBS
WV3810024816Medicare PIN
OHP01208919OtherRAILROAD MEDICARE
OH0076874Medicaid
NJ506686OtherAETNA
NJ223019073-003OtherQUALCARE