Provider Demographics
NPI:1467484873
Name:HINSON, ROBIN MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:MARIE
Last Name:HINSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 HARDSCRABBLE RD
Mailing Address - Street 2:
Mailing Address - City:CADYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12918-1908
Mailing Address - Country:US
Mailing Address - Phone:518-293-8489
Mailing Address - Fax:
Practice Address - Street 1:3384 STATE ROUTE 22
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972-5305
Practice Address - Country:US
Practice Address - Phone:518-643-8008
Practice Address - Fax:518-643-8090
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006858-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000493540003OtherBLUE SHIELD NE NY
NYAA0765Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER