Healthcare Provider Details

I. General information

NPI: 1013075175
Provider Name (Legal Business Name): RONALD B. ROBBINS, M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 WASHINGTON ST
MIDDLETOWN CT
06457-2912
US

IV. Provider business mailing address

842 WASHINGTON ST
MIDDLETOWN CT
06457-2912
US

V. Phone/Fax

Practice location:
  • Phone: 860-346-4484
  • Fax: 860-347-1343
Mailing address:
  • Phone: 860-346-4484
  • Fax: 860-347-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number024628
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number004271
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: JACQUELINE NARDI
Title or Position: OFFICE MANAGER
Credential:
Phone: 860-346-4484