Healthcare Provider Details

I. General information

NPI: 1114989126
Provider Name (Legal Business Name): MARY M ROBBINS PH.D., PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 WEST RD SUITE 400
ELLINGTON CT
06029-5710
US

IV. Provider business mailing address

137 WEST RD SUITE 400
ELLINGTON CT
06029-5710
US

V. Phone/Fax

Practice location:
  • Phone: 888-659-7009
  • Fax:
Mailing address:
  • Phone: 860-559-4942
  • Fax: 860-559-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000546
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: