Provider Demographics
NPI:1861619769
Name:RADOMILE, ROBERT (MED)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:RADOMILE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1870
Mailing Address - Country:US
Mailing Address - Phone:215-698-8910
Mailing Address - Fax:
Practice Address - Street 1:1730 WELSH RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4213
Practice Address - Country:US
Practice Address - Phone:215-698-8910
Practice Address - Fax:215-698-8946
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004718L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist