Provider Demographics
NPI:1487639274
Name:ROBINSON, JOHN CONYNGHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CONYNGHAM
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:10 HAWTHORNE PL
Practice Address - Street 2:MILTON PEDIATRIC ASSOCIATES MGH STE 110 H 10 110
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2336
Practice Address - Country:US
Practice Address - Phone:617-724-0924
Practice Address - Fax:617-724-3413
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA28838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0173517Medicaid
MA701302OtherTUFTS HEALTH PLAN
MAM07038OtherBCBS MA
E01997Medicare UPIN
MA0173517Medicaid