Provider Demographics
NPI:1689755910
Name:HENDRIKSON, ROBERT P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:HENDRIKSON
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 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-755-9166
Mailing Address - Fax:
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-9166
Practice Address - Fax:203-755-5932
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021059207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B37707Medicare UPIN
CT0378540001Medicare NSC
CT200000218Medicare ID - Type Unspecified