Provider Demographics
NPI:1336287515
Name:FORMAN ROSE, ROBIN B (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:B
Last Name:FORMAN ROSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38C GROVE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4669
Mailing Address - Country:US
Mailing Address - Phone:203-900-4416
Mailing Address - Fax:203-666-5649
Practice Address - Street 1:38C GROVE ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4669
Practice Address - Country:US
Practice Address - Phone:203-900-4416
Practice Address - Fax:203-666-5649
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT45319207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology