Healthcare Provider Details

I. General information

NPI: 1720078124
Provider Name (Legal Business Name): ROBIN H ADAIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N DEPARTMENT OF DEVELOPMENTAL BEHAVIORAL PEDIATRICS
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 671
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-7589
  • Fax: 508-856-6740
Mailing address:
  • Phone: 585-275-2986
  • Fax: 585-275-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number261394
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02395559
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: