Provider Demographics
NPI:1083677678
Name:CONSTANTINE, ROBERT M
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:CONSTANTINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-448-5440
Mailing Address - Fax:315-472-5010
Practice Address - Street 1:301 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-448-5440
Practice Address - Fax:315-472-5010
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1431921207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01034688Medicaid
NY00482031Medicaid
34852RMedicare PIN
NY00482031Medicaid
J400003679Medicare UPIN