Provider Demographics
NPI:1609146778
Name:TEDESCO, ROBIN C (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:C
Last Name:TEDESCO
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1000 ASYLUM AVENUE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-714-5058
Mailing Address - Fax:860-714-8311
Practice Address - Street 1:114 WOODLAND STREET
Practice Address - Street 2:SICU DEPT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-4694
Practice Address - Fax:860-714-8096
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2013-05-30
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Provider Licenses
StateLicense IDTaxonomies
CT363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical