Provider Demographics
NPI:1528080389
Name:O MALLEY, ROBERT BRIAN (DPM)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRIAN
Last Name:O MALLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:910-251-9880
Mailing Address - Fax:910-251-9297
Practice Address - Street 1:1505 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-251-9880
Practice Address - Fax:910-251-9297
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC418213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2433365OtherMEDICARE PTAN
NC1284510001OtherMEDICARE DMERC GROUP PTAN
NC790801MMedicaid
NC1284510001OtherMEDICARE DMERC GROUP PTAN
NC2433365Medicare ID - Type Unspecified