Provider Demographics
NPI:1639103997
Name:ROBINSON, CARL D (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:D
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:99 CAMPUS AVE STE 402
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6045
Practice Address - Country:US
Practice Address - Phone:207-777-4455
Practice Address - Fax:207-777-4458
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD155782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME330250099Medicaid
MECA0089OtherMEDICARE PTAN
MEH36910Medicare UPIN
MEMM8859Medicare PIN