Basic Information
Provider Information
NPI: 1306830187
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHELLENBERG
FirstName: ROBERT
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7200
Address2:  
City: ROCKY MOUNT
State: NC
PostalCode: 278040200
CountryCode: US
TelephoneNumber: 2529370200
FaxNumber: 2524510056
Practice Location
Address1: 901 N WINSTEAD AVE
Address2:  
City: ROCKY MOUNT
State: NC
PostalCode: 278048467
CountryCode: US
TelephoneNumber: 2529370231
FaxNumber: 2529373113
Other Information
ProviderEnumerationDate: 09/07/2005
LastUpdateDate: 03/30/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X31101NCY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

ID Information
IDTypeStateIssuerDescription
10000660701NCRAILROAD MEDICAREOTHER
897487905NC MEDICAID
5299301NCMECOSTOTHER
551799201NCCIGNA HEALTHCAREOTHER
7487901NCBCBSNCOTHER


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