Healthcare Provider Details

I. General information

NPI: 1487788352
Provider Name (Legal Business Name): KENNETH JOHN ROBINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-0001
  • Fax: 860-545-2274
Mailing address:
  • Phone: 860-545-0001
  • Fax: 860-545-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number033662
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: