Healthcare Provider Details

I. General information

NPI: 1528080389
Provider Name (Legal Business Name): ROBERT BRIAN O MALLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 MEDICAL CENTER DRIVE
WILMINGTON NC
28401
US

IV. Provider business mailing address

1505 MEDICAL CENTER DRIVE
WILMINGTON NC
28401
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-9880
  • Fax: 910-251-9297
Mailing address:
  • Phone: 910-251-9880
  • Fax: 910-251-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number418
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: