Healthcare Provider Details

I. General information

NPI: 1396784898
Provider Name (Legal Business Name): KEITH M ROBINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 1 GRAND WHITE BLDG
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3900 WOODLAND AVENUE
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3261
  • Fax: 215-349-8944
Mailing address:
  • Phone: 215-823-5220
  • Fax: 215-823-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD044380E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: