Basic Information
| Provider Information | |||||||||
| NPI: | 1699069948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVO | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3031 NEW BERN AVE | ||||||||
| Address2: | STE 306 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276102989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192313966 | ||||||||
| FaxNumber: | 9192313912 | ||||||||
| Practice Location | |||||||||
| Address1: | 3604 BUSH ST | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198767807 | ||||||||
| FaxNumber: | 9192313912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2011 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 201700839 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.