Provider Demographics
NPI:1841287687
Name:HANSEN, ROBBIN H (MD)
Entity type:Individual
Prefix:
First Name:ROBBIN
Middle Name:H
Last Name:HANSEN
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 1:25 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1244
Mailing Address - Country:US
Mailing Address - Phone:716-592-2832
Mailing Address - Fax:716-592-4452
Practice Address - Street 1:25 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1244
Practice Address - Country:US
Practice Address - Phone:716-592-2832
Practice Address - Fax:716-592-4452
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169858208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010072704OtherUNIVERA
NY000510187010OtherBC/BS
NY040426000853OtherFIDELIS
NY146922DLOtherPREFERRED CARE
NY01018524Medicaid
NY1208950OtherIHA
B40474Medicare UPIN
DD3581Medicare ID - Type Unspecified