MEDICARE: DR. ROBERT THEODORE TISHERMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	2023-01074	NC
2	207X00000X	Orthopaedic Surgery Physician	2023-01074	NC

General Provider Information

NPI Number	:	1417477423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT THEODORE TISHERMAN MD

Provider Business Mailing Address
First Line	:	3475 ERWIN RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-0005
Country	:	US
Telephone Number	:	919-660-1949
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 DUKE HEALTH CARY PL STE 120
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-6760
Country	:	US
Telephone Number	:	919-858-1203
Fax Number	:	919-385-9500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	10/24/2024

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