Provider Demographics
NPI:1164487187
Name:ROBINSON, SEAN T (PA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:T
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 1:2022 OPITZ BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3323
Mailing Address - Country:US
Mailing Address - Phone:571-398-2341
Mailing Address - Fax:571-398-6388
Practice Address - Street 1:2022 OPITZ BLVD STE B
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3323
Practice Address - Country:US
Practice Address - Phone:571-398-2341
Practice Address - Fax:571-398-6388
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1696363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ54293Medicare UPIN