Provider Demographics
NPI:1508945148
Name:PLUMMER, ROBERT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:PLUMMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:176 E MOSHOLU PKWY S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1206
Mailing Address - Country:US
Mailing Address - Phone:718-367-6100
Mailing Address - Fax:718-733-4020
Practice Address - Street 1:176 E MOSHOLU PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1206
Practice Address - Country:US
Practice Address - Phone:718-367-6100
Practice Address - Fax:718-733-4020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY158669208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01165902Medicaid
NY39F171Medicare PIN
NY01165902Medicaid