MEDICARE: ROBERT CHRISTIAN DUTLINGER PA

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	363A00000X	Physician Assistant	3548	SC

General Provider Information

NPI Number	:	1629525225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CHRISTIAN DUTLINGER PA

Provider Business Mailing Address
First Line	:	210 VILLAGE CENTER BLVD STE 140
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6706
Country	:	US
Telephone Number	:	843-353-3460
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 VILLAGE CENTER BLVD STE 200
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6706
Country	:	US
Telephone Number	:	843-353-3460
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	03/12/2026

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