Provider Demographics
NPI:1902001431
Name:KREMSDORF, ROBIN AMY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:AMY
Last Name:KREMSDORF
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 1:1 HOPPIN ST
Mailing Address - Street 2:CORO WEST
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4141
Mailing Address - Country:US
Mailing Address - Phone:401-444-5672
Mailing Address - Fax:401-444-3944
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:HASBRO 122
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-6484
Practice Address - Fax:401-444-6378
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD143712080P0210X, 208000000X
MA2361922080P0210X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD14371OtherLICENSE