Provider Demographics
NPI:1003813650
Name:TOBORG, ROBERT THEODORE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THEODORE
Last Name:TOBORG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-4820
Mailing Address - Fax:704-384-7830
Practice Address - Street 1:3333 BROOKVIEW HILLS BLVD
Practice Address - Street 2:STE 204
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5661
Practice Address - Country:US
Practice Address - Phone:336-774-3740
Practice Address - Fax:336-774-3780
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00457727OtherRAILROAD MEDICARE
NC9901057OtherMEDICAL LICENSE NUMBER
NC89129Y3Medicaid
NC2283380DMedicare PIN
NCP00457727OtherRAILROAD MEDICARE
NC9901057OtherMEDICAL LICENSE NUMBER
NC2283380CMedicare ID - Type Unspecified