Basic Information
| Provider Information | |||||||||
| NPI: | 1164508297 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBINS | ||||||||
| FirstName: | EDWIN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63213 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282633213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002791395 | ||||||||
| FaxNumber: | 5176946441 | ||||||||
| Practice Location | |||||||||
| Address1: | 1638 OWEN DRIVE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106094000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 11/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 191796 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0207X | 191796 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | 207PP0204X | 2007-00787 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01511820 | 05 | NY | MEDICAID | 5906826 | 05 | NC | MEDICAID | Q0078I | 05 | SC | MEDICAID |