Provider Demographics
NPI:1245377522
Name:FENNIMORE, ROBIN MACCOLL (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MACCOLL
Last Name:FENNIMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ROBERTON
Other - Last Name:MACCOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3911
Practice Address - Country:US
Practice Address - Phone:303-399-0055
Practice Address - Fax:303-399-7764
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48850207VM0101X, 207VX0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA102449Medicare PIN