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General NPI Number Information
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NPI Number | 1104820133
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Entity Type | Individual
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Provider Name | ROBERT HOWARD MCCONVILLE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 1125 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330-4162
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Country | US
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Telephone | 919-774-6023
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Fax | 919-776-6359
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Provider Business Mailing Address
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Address Line | 1125 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330-4162
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Country | US
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Telephone | 919-774-6023
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Fax | 919-776-6359
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20316
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License Number State | NC
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