Healthcare Provider Details

I. General information

NPI: 1902001431
Provider Name (Legal Business Name): ROBIN AMY KREMSDORF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST HASBRO 122
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

1 HOPPIN ST CORO WEST
PROVIDENCE RI
02903-4141
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-6484
  • Fax: 401-444-6378
Mailing address:
  • Phone: 401-444-5672
  • Fax: 401-444-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD14371
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD14371
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number236192
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number236192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: