MEDICARE: MAMIE MARGUERITE ROBINSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	W0716	TX
2	2085R0202X	Diagnostic Radiology Physician	350926	LA

General Provider Information

NPI Number	:	1679102693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMIE MARGUERITE ROBINSON MD

Provider Business Mailing Address
First Line	:	8230 SUMMA AVE STE C
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3465
Country	:	US
Telephone Number	:	225-757-0552
Fax Number	:	225-763-9997

Provider Business Practice Location Address
First Line	:	22999 HIGHWAY 59 N
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-4412
Country	:	US
Telephone Number	:	281-348-3320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	04/06/2026

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