Basic Information
Provider Information | |||||||||
NPI: | 1912123142 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOCKE | ||||||||
FirstName: | ROBIN | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 361 OLD BELGRADE RD | ||||||||
Address2: | ALFOND CANCER CENTER | ||||||||
City: | AUGUSTA | ||||||||
State: | ME | ||||||||
PostalCode: | 043308058 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2076216100 | ||||||||
FaxNumber: | 2076216102 | ||||||||
Practice Location | |||||||||
Address1: | 361 OLD BELGRADE RD | ||||||||
Address2: | ALFOND CANCER CENTER | ||||||||
City: | AUGUSTA | ||||||||
State: | ME | ||||||||
PostalCode: | 043308058 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2076216100 | ||||||||
FaxNumber: | 2076216102 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2007 | ||||||||
LastUpdateDate: | 04/18/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 241974 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 018128 | ME | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 434163299 | 05 | ME |   | MEDICAID | 1912123142 | 05 | ME |   | MEDICAID |