Provider Demographics
NPI:1972966349
Name:WILLARD, ROBIN (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:WILLARD
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 1:417 STATE ST
Mailing Address - Street 2:WEBBER MEDICAL BUILDING, SUITE 421
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6639
Mailing Address - Country:US
Mailing Address - Phone:207-275-0881
Mailing Address - Fax:
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:WEBBER MEDICAL BUILDING, SUITE 421
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6639
Practice Address - Country:US
Practice Address - Phone:207-275-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEMD28057208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program