Healthcare Provider Details

I. General information

NPI: 1124136346
Provider Name (Legal Business Name): SUSAN WENGER ROBBINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S BROAD ST HEALTH CARE CENTER #2
PHILADELPHIA PA
19145-2315
US

IV. Provider business mailing address

500 S BROAD ST SUITE 360
PHILADELPHIA PA
19146-1613
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-1803
  • Fax: 215-683-1815
Mailing address:
  • Phone: 215-685-6769
  • Fax: 215-685-6732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD021736E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: