Provider Demographics
NPI:1932180221
Name:ROBERT, MARIE EMMA (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:EMMA
Last Name:ROBERT
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 1:310 CEDAR ST
Mailing Address - Street 2:LAUDER HALL, ROOM 108
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3218
Mailing Address - Country:US
Mailing Address - Phone:203-785-3624
Mailing Address - Fax:203-785-7037
Practice Address - Street 1:310 CEDAR ST
Practice Address - Street 2:LAUDER HALL, ROOM 108
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3218
Practice Address - Country:US
Practice Address - Phone:203-785-3624
Practice Address - Fax:203-785-7037
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033691207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001336917Medicaid
CT001336917Medicaid
CT220000437Medicare ID - Type Unspecified