MEDICARE: DR. ROBERT HOWARD MCCONVILLE JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20316	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	412013354	OTHER	NC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0138851	OTHER	NC	UNITED HEALTHCARE
3	270326	OTHER	NC	MAMSI
4	133545617	OTHER	NC	TRICARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	3913	OTHER	NC	PARTNERS
7	27772	OTHER	NC	MEDCOST
8	55856	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1104820133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT HOWARD MCCONVILLE JR. MD

Provider Business Mailing Address
First Line	:	1125 CARTHAGE ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4162
Country	:	US
Telephone Number	:	919-774-6023
Fax Number	:	919-776-6359

Provider Business Practice Location Address
First Line	:	1125 CARTHAGE ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4162
Country	:	US
Telephone Number	:	919-774-6023
Fax Number	:	919-776-6359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	06/23/2022

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Directions to “ DR. ROBERT HOWARD MCCONVILLE JR. MD” Practice Location

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