Provider Demographics
NPI:1245226091
Name:GALVIN, ROBIN LOUISE (NP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LOUISE
Last Name:GALVIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:MOORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:830 OAK ST
Mailing Address - Street 2:STE 105W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1168
Mailing Address - Country:US
Mailing Address - Phone:508-427-3668
Mailing Address - Fax:508-427-2610
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:STE 105W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:508-427-3668
Practice Address - Fax:508-427-2610
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164462363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0316971Medicaid
P88340Medicare UPIN
MANP4161Medicare ID - Type Unspecified