Provider Demographics
NPI:1669518379
Name:ROBINSON, DERRICK M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:M
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:407 EAST AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5299
Mailing Address - Country:US
Mailing Address - Phone:401-725-4700
Mailing Address - Fax:
Practice Address - Street 1:407 EAST AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5299
Practice Address - Country:US
Practice Address - Phone:401-725-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPA00050-G363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant