Healthcare Provider Details

I. General information

NPI: 1023186202
Provider Name (Legal Business Name): THEODORE BENNETT ROBBINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 UNION STREET
SPRINGFIELD VT
05156
US

IV. Provider business mailing address

ONE HOSPITAL COURT SUITE 410
BELLOWS FALLS VT
05101
US

V. Phone/Fax

Practice location:
  • Phone: 802-885-4598
  • Fax: 802-885-1508
Mailing address:
  • Phone: 802-463-3947
  • Fax: 802-463-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0420004546
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: