Provider Demographics
NPI:1629096821
Name:WINN, ROBERT JERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JERALD
Last Name:WINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 HADDON AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2825
Mailing Address - Country:US
Mailing Address - Phone:856-656-6859
Mailing Address - Fax:856-240-1829
Practice Address - Street 1:318 HADDON AVE FL 1
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2825
Practice Address - Country:US
Practice Address - Phone:856-656-6859
Practice Address - Fax:856-240-1829
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071471L207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0053597Medicaid
NJ0053597Medicaid
PA049713Medicare PIN