Provider Demographics
NPI:1740363183
Name:ROBINSON, LUTHER KNOX (MD)
Entity type:Individual
Prefix:
First Name:LUTHER
Middle Name:KNOX
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 BARTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1573
Mailing Address - Country:US
Mailing Address - Phone:716-881-6191
Mailing Address - Fax:716-881-6247
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7530
Practice Address - Fax:716-878-1351
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170810208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00010149001OtherUNIVERA
0017511100001OtherPA MEDICAID
I205781OtherIHA
NY01042277Medicaid
040426000984OtherFIDELIS
000510280001OtherBC/BS
NY01042277Medicaid
NYL86907Medicare PIN