Healthcare Provider Details

I. General information

NPI: 1508889643
Provider Name (Legal Business Name): ROBERT PASQUALE RASPA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 JOHN J DELANEY DR SUITE 100
CHARLOTTE NC
28277-3146
US

IV. Provider business mailing address

4601 PARK RD SUITE 300
CHARLOTTE NC
28209-3239
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-3410
  • Fax: 704-323-3402
Mailing address:
  • Phone: 704-323-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00078500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02781
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: