Basic Information
| Provider Information | |||||||||
| NPI: | 1669623260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERSON FOOT CARE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 AVON AVE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278893841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529461181 | ||||||||
| FaxNumber: | 2529462309 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 AVON AVE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278893841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529461181 | ||||||||
| FaxNumber: | 2529462309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2008 | ||||||||
| LastUpdateDate: | 08/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | RUSEVLYAN | ||||||||
| AuthorizedOfficialFirstName: | AINSLEY | ||||||||
| AuthorizedOfficialMiddleName: | ROBERSON | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2529461181 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 518 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
No ID Information.