Healthcare Provider Details

I. General information

NPI: 1720076730
Provider Name (Legal Business Name): MICHAEL ANDREW ROBINSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 LOWER DALLAS HWY
DALLAS NC
28034-9368
US

IV. Provider business mailing address

824 LOWER DALLAS HWY
DALLAS NC
28034-9368
US

V. Phone/Fax

Practice location:
  • Phone: 704-874-0200
  • Fax:
Mailing address:
  • Phone: 704-874-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102406
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: