Provider Demographics
NPI:1063405744
Name:RENFROE, ROBIN P (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:P
Last Name:RENFROE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4346
Mailing Address - Country:US
Mailing Address - Phone:860-529-9933
Mailing Address - Fax:860-529-7156
Practice Address - Street 1:1331 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4346
Practice Address - Country:US
Practice Address - Phone:860-529-9933
Practice Address - Fax:860-529-7156
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT79878208000000X
AL37761208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25978OtherBCBS
FL376274200Medicaid
FL9581OtherHEALTH 1ST NETWORK
AL227044Medicaid
FL25978OtherBCBS