Provider Demographics
NPI:1134320518
Name:ROBINSON, GEOFFREY P (PA)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:P
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 HEBRON AVE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2410
Mailing Address - Country:US
Mailing Address - Phone:860-696-2250
Mailing Address - Fax:860-696-2260
Practice Address - Street 1:676 HEBRON AVE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2410
Practice Address - Country:US
Practice Address - Phone:860-696-2250
Practice Address - Fax:860-696-2260
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1134320518OtherNPI
CT1134320518Medicare PIN