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General NPI Number Information
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NPI Number | 1972603132
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Entity Type | Organization
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Legal Business Name | ROBESON MEDICAL CLINIC PC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 4320 FAYETTEVILLE RD SUITE A
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City | LUMBERTON
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State | NC
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Zip | 28358-2706
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Country | US
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Telephone | 910-738-2330
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Fax | 910-738-1403
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Provider Business Mailing Address
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Address Line | 4320 FAYETTEVILLE RD SUITE A
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City | LUMBERTON
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State | NC
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Zip | 28358-2706
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Country | US
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Telephone | 910-738-2330
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Fax | 910-738-1403
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Authorized Official
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Title or Position | CEO
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Name | SANDHYA ANNE THOMASMONTILUS
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Credential | M.D.
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Telephone | 910-738-2330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9701618
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License Number State | NC
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