Provider Demographics
NPI:1114117140
Name:ROBIN MAHABIR, M.D, P.C
Entity Type:Organization
Organization Name:ROBIN MAHABIR, M.D, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHABIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-888-9940
Mailing Address - Street 1:100 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1990
Mailing Address - Country:US
Mailing Address - Phone:203-888-9940
Mailing Address - Fax:203-888-2499
Practice Address - Street 1:100 OXFORD RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1990
Practice Address - Country:US
Practice Address - Phone:203-888-9940
Practice Address - Fax:203-888-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034002261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1340223Medicaid
CTF96169Medicare UPIN
CT1340223Medicaid