Provider Demographics
NPI:1487215869
Name:JONES, ROBIN THERESA (MED)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:THERESA
Last Name:JONES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4737
Mailing Address - Country:US
Mailing Address - Phone:215-915-3141
Mailing Address - Fax:
Practice Address - Street 1:5905 N LEITHGOW ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1830
Practice Address - Country:US
Practice Address - Phone:215-915-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA42433601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA42433601Medicaid