Provider Demographics
NPI:1780623124
Name:RICKETTS, ROBYN (MD)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LIBERTY TRL
Mailing Address - Street 2:SUITE 313
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1340
Mailing Address - Country:US
Mailing Address - Phone:215-715-0737
Mailing Address - Fax:215-938-3422
Practice Address - Street 1:90 BRICK RD
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2177
Practice Address - Country:US
Practice Address - Phone:215-715-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425203207L00000X
NJ207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101100219001Medicaid
PA085860FWJMedicare PIN
PA101100219001Medicaid
PA085860Medicare ID - Type Unspecified