Provider Demographics
NPI:1306841564
Name:ROBINSON, EDWIN G (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:G
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GLENSIDE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3769
Mailing Address - Country:US
Mailing Address - Phone:804-288-0399
Mailing Address - Fax:804-285-0088
Practice Address - Street 1:1800 GLENSIDE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3769
Practice Address - Country:US
Practice Address - Phone:804-288-0399
Practice Address - Fax:804-285-0088
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010354366Medicaid
VAP00648490OtherRR MEDICARE
VAC09933OtherMEDICARE GROUP NUMBER
VAMC10798Medicare PIN
VA010354366Medicaid
VAE13710Medicare UPIN
NCE13710Medicare UPIN
VA011531H33Medicare PIN
VAC09933OtherMEDICARE GROUP NUMBER