Healthcare Provider Details

I. General information

NPI: 1275516221
Provider Name (Legal Business Name): ROBERT DELANCY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 MAYNARD ST 43RD MEDICAL GROUP
POPE AFB NC
28308-2321
US

IV. Provider business mailing address

1030 MAGNOLIA DR
ABERDEEN NC
28315-2230
US

V. Phone/Fax

Practice location:
  • Phone: 910-394-4084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: