Provider Demographics
NPI:1396784898
Name:ROBINSON, KEITH M (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:M
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 WOODLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-823-5220
Mailing Address - Fax:215-823-4207
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:1 GRAND WHITE BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-3261
Practice Address - Fax:215-349-8944
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044380E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011723500001Medicaid
B96416Medicare UPIN
PA0011723500001Medicaid