Provider Demographics
NPI:1154418879
Name:COFFIN, ROBERT RUSSEL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RUSSEL
Last Name:COFFIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:24 INDIAN MOUND DR
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-2217
Mailing Address - Country:US
Mailing Address - Phone:315-624-8242
Mailing Address - Fax:315-624-8206
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1068
Practice Address - Country:US
Practice Address - Phone:315-624-8242
Practice Address - Fax:315-624-8206
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY170400207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology