Provider Demographics
NPI:1083815492
Name:ROBERT G DORR
Entity type:Organization
Organization Name:ROBERT G DORR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-488-8345
Mailing Address - Street 1:420 E MAIN ST
Mailing Address - Street 2:#6
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-488-8345
Mailing Address - Fax:203-483-8668
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:#6
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405
Practice Address - Country:US
Practice Address - Phone:203-488-8345
Practice Address - Fax:203-483-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT04162484Medicaid