Doctor Name: | ROBIN LINCOLN ELLEDGE |
NPI Number: | 1558434159 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | 102542 |
Business Practice Address: | 1418 N Main St Fuquay Varina, NC - 275268901 |
Business Phone Number: | 9195521733 |
Business Fax Number: | 9195521495 |
Mailing Address: | 1418 N Main St, FUQUAY VARINA |
State: | NC |
Postal Code: | 275268901 |
Phone Number: | 9195521733 |
Fax Number: | 9195521495 |
NPI Enumeration Date: | 11/15/2006 |
NPI Last Update Date: | 04/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 102542 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |