Individual
ROBYN BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
10 DAVOL SQ, SUITE 400, PROVIDENCE, RI 02903-4754
(401) 421-4000
(401) 272-1456
Mailing address
10 DAVOL SQ, SUITE 400, PROVIDENCE, RI 02903-4754
(401) 421-4000
(401) 272-1456
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00341
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27960-0
BCBS OF RI
RI
01
—
411838
BLUE CHIP
SC
05
—
9003736
—
RI
Enumeration date
09/29/2005
Last updated
07/08/2007
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