Healthcare Provider Details

I. General information

NPI: 1952400806
Provider Name (Legal Business Name): OMALLEY FOOT AND ANKLE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 MEDICAL CENTER DR
WILMINGTON NC
28401-7507
US

IV. Provider business mailing address

1505 MEDICAL CENTER DR
WILMINGTON NC
28401-7507
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 Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number418
License Number StateNC

VIII. Authorized Official

Name: MR. ROBERT BRIAN OMALLEY
Title or Position: PRESIDENTOWNER
Credential: DPM
Phone: 910-251-9880