Provider Demographics
NPI:1821012238
Name:PEMBERTON, ROBYN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 UNION STREET
Mailing Address - Street 2:ROCKVILLE GENERAL HOSPITAL
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066
Mailing Address - Country:US
Mailing Address - Phone:860-872-5152
Mailing Address - Fax:860-872-5257
Practice Address - Street 1:31 UNION STREET
Practice Address - Street 2:ROCKVILLE GENERAL HOSPITAL
Practice Address - City:ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-872-5152
Practice Address - Fax:860-872-5257
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042621208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics