Provider Demographics
NPI:1073977104
Name:ROBINSON, JERRY EMMETT III (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:EMMETT
Last Name:ROBINSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-652-9555
Mailing Address - Fax:717-221-5600
Practice Address - Street 1:1830 GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1233
Practice Address - Country:US
Practice Address - Phone:717-652-9555
Practice Address - Fax:717-221-5600
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61122990207X00000X
PAMD479991207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073977104Medicaid