Provider Demographics
NPI:1225098924
Name:MAYFIELD, ROBIN STANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:STANTON
Last Name:MAYFIELD
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:PO BOX 470438
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE VILLAGE
Mailing Address - State:MA
Mailing Address - Zip Code:02447-0438
Mailing Address - Country:US
Mailing Address - Phone:617-794-1463
Mailing Address - Fax:617-739-1963
Practice Address - Street 1:32 KENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7902
Practice Address - Country:US
Practice Address - Phone:617-794-1463
Practice Address - Fax:617-739-1963
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78290207R00000X, 208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3130266Medicaid
MAJ14325Medicare ID - Type Unspecified
MAF71191Medicare UPIN