Provider Demographics
NPI:1154495950
Name:EVANS, ROBIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:D
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 SUMMER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5315
Mailing Address - Country:US
Mailing Address - Phone:203-323-5660
Mailing Address - Fax:
Practice Address - Street 1:1275 SUMMER ST STE 101
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5315
Practice Address - Country:US
Practice Address - Phone:203-323-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030597207N00000X
NY1821531207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1992879795OtherMEDICARE GROUP NPI
CTE46249Medicare UPIN
CT1992879795OtherMEDICARE GROUP NPI
CT070000341Medicare ID - Type Unspecified