Basic Information
| Provider Information | |||||||||
| NPI: | 1205022639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIGMORE | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 WORCESTER SQ | ||||||||
| Address2: | APARTMENT 1 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176327706 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 BROOKLINE AVE E/SHAPIRO 6TH FLOOR | ||||||||
| Address2: | BETH ISRAEL DEACONESS MEDICAL CENTER HCA | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177549600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 09/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 233380 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 233380 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.