1770891210 NPI number — MR. DAVID A ROBISON FNP-BC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770891210 NPI number — MR. DAVID A ROBISON FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBISON
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770891210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E 2ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28052-4358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-874-1904
Provider Business Mailing Address Fax Number:
704-874-0707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2721 X RAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054-7491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-874-2255
Provider Business Practice Location Address Fax Number:
704-810-7417
Provider Enumeration Date:
09/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  4335 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 5010071 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CE1315 . This is a "MEDICARE RAILROAD GROUP #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP0641 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 423876 . This is a "RHC MEDICARE (INDIANLAND)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: RHC127 . This is a "RHC MEDICAID (LANCASTER)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: RHC211 . This is a "RHC MEDICAID (INDIANLAND)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 428960 . This is a "RHC MEDICARE (LANCASTER)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: NP1692 . This is a "MEDICAID INDIVIDUAL PROVIDER ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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