Provider Demographics
NPI:1023089745
Name:BALLINA, ROBIN REGINA (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:REGINA
Last Name:BALLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:R
Other - Last Name:BALLINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:325 FRONT ST
Mailing Address - Street 2:#328
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3633
Mailing Address - Country:US
Mailing Address - Phone:801-319-4726
Mailing Address - Fax:307-789-1283
Practice Address - Street 1:325 FRONT ST
Practice Address - Street 2:#328
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3633
Practice Address - Country:US
Practice Address - Phone:801-319-4726
Practice Address - Fax:307-789-1283
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181591-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYBB0471881OtherDEA
TXA10494Medicare UPIN