Provider Demographics
NPI:1114989126
Name:ROBBINS, MARY M (PHD, PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:PHD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 WEST RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-5710
Mailing Address - Country:US
Mailing Address - Phone:860-559-4942
Mailing Address - Fax:860-559-4942
Practice Address - Street 1:137 WEST RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-5710
Practice Address - Country:US
Practice Address - Phone:888-659-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000546363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970002301Medicare PIN
CTS90751Medicare UPIN