Provider Demographics
NPI:1184820862
Name:ROBINSON, CHRISTIAN MARIE (MAOM, LIC AC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIAN
Middle Name:MARIE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MAOM, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4011
Mailing Address - Country:US
Mailing Address - Phone:508-668-6542
Mailing Address - Fax:508-668-6542
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4011
Practice Address - Country:US
Practice Address - Phone:508-668-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226519261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service