1134222615 NPI number — DR. MALCOLM CLIVE ROBINSON MD

Table of content: (NPI 1952176794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134222615 NPI number — DR. MALCOLM CLIVE ROBINSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
MALCOLM
Provider Middle Name:
CLIVE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134222615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2660 MAIN ST
Provider Second Line Business Mailing Address:
SUITE216
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06606-5369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-576-5346
Provider Business Mailing Address Fax Number:
203-581-6509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 MAIN ST
Provider Second Line Business Practice Location Address:
CARDIOTHORACIC SURG
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06606-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-576-5708
Provider Business Practice Location Address Fax Number:
203-367-8392
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  038020 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 038020 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2463663 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5718716 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6644692-004 . This is a "CIGNA HEALTHPLAN HMO/POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6644692-002 . This is a "CIGNA HEALTHPLAN PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001380203 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: P0107001 . This is a "MEDSPAN GROUP ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06-1605784 . This is a "HEALTHCARE VALUE MNGMT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0V8239 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2218963 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010038020CT01 . This is a "ANTHEM BC/BS OF CT" identifier . This identifiers is of the category "OTHER".




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