Provider Demographics
NPI:1477599421
Name:PORGES, ROBIN E (APRN-BC, CADAC-II)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:E
Last Name:PORGES
Suffix:
Gender:F
Credentials:APRN-BC, CADAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MAIN STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053
Mailing Address - Country:US
Mailing Address - Phone:508-533-8868
Mailing Address - Fax:508-533-8867
Practice Address - Street 1:89 MAIN STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053
Practice Address - Country:US
Practice Address - Phone:508-533-8868
Practice Address - Fax:508-533-8867
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN-PC146031364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0502Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
MAS52329Medicare UPIN