Provider Demographics
NPI:1679517726
Name:FOX, ROBERT DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 OLD YORK RD.
Mailing Address - Street 2:SUITE 312
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3709
Mailing Address - Country:US
Mailing Address - Phone:215-576-1212
Mailing Address - Fax:215-576-1220
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:SUITE 312
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3706
Practice Address - Country:US
Practice Address - Phone:215-576-1212
Practice Address - Fax:215-576-1220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022818E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA405784Medicare ID - Type Unspecified
PAC33504Medicare UPIN